• CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (11/20)

    Monday, November 23, 2020 | CDC

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • Residents With Acute Respiratory Symptoms? CDC Testing and Management Considerations When SARS-COV-2 and Influenza Co-Circulate (11/20)

    Monday, November 23, 2020 | CDC
    This document contains practices that should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities.
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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (11/20)

    Sunday, November 15, 2020 | CMS

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit (updated 11/22/20) developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CMS Will Retire Nursing Home Compare Tool and Fully Transition to Care Compare on December 1 (11/20)

    Sunday, November 15, 2020 | CMS
    CMS will retire the original Compare Tools on December 1st. Use Medicare.gov’s Care Compare to find and compare health care providers.

    In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines our eight original health care compare tools.  Since then, you’ve had the opportunity to use and familiarize yourself with Care Compare while having the option to use the original compare tools, too.  You’ve also been able to share feedback from a survey directly on Care Compare and we’ve received lots of great feedback so far.

    The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1st, ending this transition period. If you haven’t been using Care Compare, we urge you to:

    ·  Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.

    ·  Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.

    Care Compare offers a new design that makes it easier to find the same information that’s on the original compare tools. It gives you, patients, and caregivers one user-friendly place to find cost, quality of care, service volume, and other CMS quality data to help make informed health care decisions.

    Now, instead of having to search through many compare tools, with just one click on Care Compare, you’ll find easy-to-understand information about nursing homes, hospitals, doctors, and other health care providers.

    Please remember that when we retire the 8 original compare tools, you will still be able to find information about health care providers and CMS quality data on Care Compare, as well as download CMS publicly reported data from the Provider Data Catalog on CMS.gov.  Fully transitioning to these tools does not change how CMS measures quality. In addition, we’ll continue to make improvements to Care Compare and the Provider Data Catalog based on stakeholder and consumer feedback now and in the future. 

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  • HHS Sends Incentive Payments to Nursing Homes Curbing COVID-19 Deaths / Infections (10/20)

    Thursday, October 29, 2020 | HHS

    The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing it will distribute approximately $333 million in first round performance payments to over 10,000 nursing homes. These nursing homes are being recognized for demonstrating significant reductions in COVID-19 related infections and deaths between August and September. This announcement illustrates how complementing relief payments with outcome-based payments help to yield positive results in improving quality and infection control in nursing homes.

    "These $333 million in performance payments are going to nursing homes that have maintained safer environments for residents between August and September," said HHS Secretary Alex Azar. "We've provided nursing homes with resources and training to improve infection control, and we're rapidly providing incentives to those facilities that are making progress in the fight against COVID-19."

    Nursing homes have been particularly hard hit by this pandemic. In response, the Trump Administration has employed a number of strategies to protect nursing home residents and slow the spread of COVID-19. In addition to General Distribution funding through the Provider Relief Fund program, HHS dedicated almost $5 billion in targeted funding to nursing homes in May.  HHS then announced another $5 billion opportunity in August. Of this amount, HHS distributed $2.5 billion in early September to help nursing homes with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs. Another $2 billion is being used to create an incentive program divided into five performance cycles. This performance-based payment structure will reward nursing homes for keeping new COVID-19 infection and mortality rates among residents lower than the communities they serve, as analyzed against CDC data.

    Nursing Home Performance-Based Results

    Today, HHS is announcing that in the first round of the incentive program, which compared data from August to September, 10,631 nursing homes, or over 77 percent of the 13,795 eligible, met the infection control criteria. Overall, these nursing homes contributed to 5,000 fewer COVID-19 infections in nursing homes in September than in August. Against both the infection control and mortality criteria, 10,501 nursing homes, or 76 percent, qualified for payments and contributed to 1,200 fewer COVID-19 related nursing home deaths between August and September.

    Nursing homes will receive September quality incentive payments next week and will have four more opportunities to receive additional incentive payments.

    HHS is encouraged by the promising September results but recognize this virus is dynamic and there is still opportunity for continued improvement. Safeguarding nursing home residents from the perils of this devastating pandemic will remain a top priority for HHS.

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  • SNF QRP October Refresh 2020: Six New Measures Publicly Reported (10/20)

    Thursday, October 29, 2020 | CMS

    The October 2020 refresh of SNF QRP data is now available on Nursing Home Compare (NHC), as well as the Nursing homes including rehab services web pages within Care Compare (CCXP) and Provider Data Catalog (PDC).

    The data are based on quality assessment data submitted by SNFs to CMS from Quarter 1 2019 through Quarter 4 2019 (01/01/2019 –12/31/2019); and the annual update of the claims-based measures data from Quarter 4 2017 – Quarter 3 2019 (10/01/2017 – 9/30/2019).

    Starting in October 2020, six additional SNF QRP measures will be publicly reported on NHC, CCXP and PDC:

    ·  Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury,

    ·  Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP,

    ·  Application of IRF Functional Outcome Measure: Change in Self-Care (NQF #2633),

    ·  Application of IRF Functional Outcome Measure: Change in Mobility (NQF #2634),

    ·  Application of IRF Functional Outcome Measure: Discharge Self-Care Score (NQF #2635), and

    ·  Application of IRF Functional Outcome Measure: Discharge Mobility Score (NQF #2636).


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  • Five-Star Technical User's Guide Plus Claims-Based Measures Appendix (10/20)

    Thursday, October 29, 2020 | CMS

    CMS created the Five-Star (5-Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated twice in October 2019.


    CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. This manual provides in-depth descriptions of the ratings and the methods used to calculate them. 

    October 2020 Revisions

    Staffing Rating Changes: Starting with the October 2020 refresh of Nursing Home Compare (NHC), CMS will resume updating PBJ staffing measures and staffing ratings, using the data submitted for the August 14, 2020 deadline (covering April – June 2020). During the time these data are reported on NHC (October - December 2020), facilities that did not report staffing for the August 14 deadline or that reported four or more days in the quarter with no registered nurse will have their staffing ratings suppressed. Their staffing ratings will show “Not Available”. Starting with the January 2021 refresh of NHC, when staffing data submitted by the November 14, 2020 deadline will be reported and used for the five-star ratings, nursing homes that do not report staffing data for July – September 2020 or that report four or more days in the quarter with no registered nurse will have their staffing ratings reduced to one star. Case-Mix adjustment will be based on the concurrent RUG-IV distribution.

    Quality Measure Rating Changes: Starting with the October 2020 refresh of Nursing Home Compare, a new quality measure (Percentage of residents with pressure ulcers/injuries that are new or worsened) will replace the current short-stay pressure ulcer measure. This new measure is also sometimes referred to by the official measure title of “Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury.” This measure will still contribute between 20 and 100 points to the short-stay QM score. Additional detail is included in the Quality Measure rating section of this document and Table A2. More information about the public reporting of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measures is available here. Note that due to the COVID-19 public health emergency, CMS is not currently using any MDS-based or claims-based Quality Measure data after December 31, 2019 for reporting on NHC or in the Quality Measure Rating. CMS will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.

    Health Inspection Rating Changes: Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to include only data from surveys that occurred on or before March 3, 2020. Results of health inspections conducted on or after March 4, 2020, will be posted publicly, but not be used to calculate a nursing home's health inspection star ratings. CMS will continue to monitor inspections, including the restarting of certain inspections (i.e., surveys) per CMS memoranda QSO-20-31-ALL and QSO-20-35-ALL. CMS will restart the inspection ratings as soon as possible and will communicate any changes to stakeholders in advance of updating the Nursing Home Compare website.


    January 2020 addition: Technical specifications for claims-based measures


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  • MDS 3.0 Quality Measures (QM) User's Manual V14.0 (10/20)

    Tuesday, October 20, 2020 | CMS

    The MDS 3.0 QM User’s Manual V14.0 has been posted. The MDS 3.0 QM User’s Manual V14.0 contains detailed specifications for the MDS 3.0 quality measures and includes a Notable Changes section that summarizes the major changes from MDS 3.0 QM User’s Manual V13.0. The MDS 3.0 QM User’s Manual V14.0 can be found below, grouped with other Skilled Nursing Facility (SNF) and Nursing Home user’s manuals in a zip file titled Users-Manuals-Updated-10-19-2020.  The zip file titled User Manuals - Updated 01-21-2020 (ZIP) containing the MDS 3.0 QM User’s Manual V13.0 has been moved to the Quality Measures Archive webpage.

    Five files have been posted:

    1. MDS 3.0 QM User’s Manual V14.0 (MDS-3_0-QM-USERS-MANUAL-v14_0.pdf) contains detailed specifications for the MDS 3.0 quality measures, as well as the Quality Measure Reporting Module Table that documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. MDS 3.0 QM User’s Manual V14.0 is available under the Downloads section of this webpage.
    2. Nursing Home Compare Claims-based Quality Measure Technical Specifications (Nursing Home Compare Claims-based Measures Tech Specs.pdf) contains detailed technical specifications for all nursing home quality measures.
    3. Nursing Home Compare Quality Measures Technical Specifications Appendix (APPENDIX - Claims-based measuresTechnical Specifications.pdf) contains tables and appendices related to the Nursing Home Compare Claims-based Quality Measures.
    4. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual V3.0 (SNF Measure Calculations and Reporting User's Manual V3.0_FINAL_508C_081419.pdf) contains detailed specifications for all SNF QRP Quality Measures.
    5. SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 (SNF-QRP-QM-Users-Manual-V3_0_1-Addendum-Change-Table.pdf) contains appendices for the SNF QRP Measure Calculations and Reporting Manual V3.0, including a risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks.
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  • SNF QRP COVID-19 PR Tip Sheet Updated (10/20)

    Thursday, October 1, 2020 | CMS
    An updated version of the SNF COVID-19 PR Tip Sheet that was posted on September 8, 2020, is now available. The purpose of this Tip Sheet is to help providers understand CMS’ public reporting strategy for the PAC QRP in the midst of the COVID-19 public health emergency (PHE).  This Tip Sheet explains the CMS strategy to account for CMS quality data which were exempted from public reporting due to COVID-19, and the impact on CMS’ Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) data on the Nursing Home Compare website refreshes.  
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  • AHRQ Establishes National Nursing Home COVID Action Network, Seeks Participants (9/20)

    Tuesday, September 29, 2020 | AHRQ

    Press Release Date: September 29, 2020

    The Agency for Healthcare Research and Quality (AHRQ) is partnering with the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston to establish a National Nursing Home COVID Action Network. The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff.

    Nursing home residents are especially vulnerable to SARS-COV-2 (COVID-19) due to their age, their underlying frailty, and their communal living conditions. And nursing home staff who care for them are among the most needed and most at-risk essential workers. It is estimated that almost 56,000 nursing home residents and staff have died from COVID-19, representing more than one-quarter of the nation’s known COVID-19 deaths.

    "Protecting vulnerable older Americans in nursing homes is a central part of our fight against COVID-19, and we’ve learned that improving infection control in many nursing homes is not a matter of will but of skill," said HHS Secretary Alex Azar. "AHRQ is deploying its unique expertise in partnership with Project ECHO and IHI to help nursing homes protect both their residents and staff from the virus, slowing the spread and saving lives."

    "Expanding the use of proven safety practices will directly benefit nursing home residents and staff members and help save lives," said AHRQ Director Gopal Khanna, M.B.A. "AHRQ has a proven track record of producing science and research to address critical needs such as responding to COVID-19 and achieving 21st century care for all Americans. We are pleased to be working with the ECHO Institute and IHI on this new initiative."

    The new network is being created under an AHRQ contract worth up to $237 million that is part of the nearly $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. While $2.5 billion has already been distributed to help fund testing, personal protective equipment, and other supplies, another $2 billion is available for Medicare and Medicaid-certified nursing homes that show improvement in infection control.

    The ECHO Institute is recruiting academic medical centers and large health centers across the country to serve as training centers for local nursing homes. Over 15,000 nursing homes that are certified to participate in the Medicare and Medicaid programs will be able to participate in a 16-week training program using a standardized curriculum developed by the IHI. Nursing homes that actively participate are eligible to receive $6,000 in compensation to cover staff training time.

    While the curriculum will continue to be refined as new evidence emerges and the pandemic evolves, topics to be covered in the early weeks include:

    • Best Practices in the Use of Personal Protective Equipment for COVID-19.
    • Making the Environment Safe during COVID-19 through Infection Control Practices.
    • Minimizing the Spread of COVID-19.
    • COVID-19 Testing.
    • Clinical Management of Asymptomatic and Mild Cases of COVID-19.
    • Managing Social Isolation during COVID.

    Weekly virtual training sessions will be facilitated by small multidisciplinary teams of subject matter and quality improvement experts. Sessions will combine short lectures that provide immediately usable best practices with case-based group learning. Between sessions, a robust community of practice will foster peer-to-peer learning supported by additional expert consultation.

    "Collaborative education and shared learning is critical for our nonprofit nursing home members on the front line of this pandemic, under often challenging conditions," said Katie Smith Sloan, president and CEO of LeadingAge. "Access to mentors, local experts, community peers, and resources, with a focus on continuous improvement, will go a long way to help mitigate the virus’ spread and ensure the health and safety of older adults."

    Sanjeev Arora, M.D., Project ECHO’s director and founder, said he looks forward to leading the initiative in partnership with AHRQ. "At a time when the dissemination of best practices in health care is more critical than ever, we are honored to help address this urgent need for nursing homes," he said.

    Project ECHO (Extension for Community Healthcare Outcomes) was established to provide training and telementoring for health care professionals and staff across the nation and around the world. It includes over 250 training partners across the United States. AHRQ funded the initial establishment and evaluation of Project ECHO beginning in 2004. The new network’s training program will use the evidence-based process pioneered by Project ECHO and referred to as the ECHO Model, which is an interactive, case-based approach based on adult learning principles.

    "The ECHO model is a proven approach that brings experts and providers together to learn and solve clinical and operational challenges," said Mark Parkinson, President and CEO for the American Health Care Association/National Center for Assisted Living. "We strongly encourage providers to participate in the COVID Action Network to get access to experts and learn the latest best practices to prevent the spread of COVID-19."

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