Archive for the News Category

Six New Quality Measures Officially Added to Nursing Home Compare, Provide Insight Into Short-Stay Outcomes

Authored by Kristine A. Schaan, M.A., CPG, NHA, Consultant

The addition of six new Nursing Home Compare quality measures has just been confirmed by the Centers for Medicare & Medicaid Services (CMS). Three of the new quality measures are based on Medicare-claims data submitted by hospitals, in contrast to data that has historically all been self-reported. The same claims-based measures also provide insight into short-stay resident outcomes. Specifically, these new claims and outcome-based measures include:

  • Percent of short-stay residents successful discharged to community
  • Percent of short-stay residents with outpatient emergency department visits
  • Percent of short-stay residents re-hospitalized after a nursing home admission

In addition, the other three measures added are MDS-based and include:

  • Percent of short-stay residents who experience improvements in function
  • Percent of long-stay residents whose independent mobility worsened
  • Percent of long-stay residents who received an anti-anxiety or hypnotic medication

Come July 2016, all measures with exception of the anti-anxiety or hypnotic medication measure will be incorporated into the Nursing Home Five-Star Quality Rating System. The anti-anxiety or hypnotic medication measure is being precluded by CMS as an appropriate benchmark has not yet been determined.

The addition of these measures provides consumers as well as health care providers with a more robust data set when making decisions on selecting a facility, whether that be for a loved one (consumer perspective) or as a hospital searching for preferred partners (health care provider perspective). Moreover, the move to incorporate outcome-based measures supports CMS in its pursuit of value-based payment.

Why Preferred SNF Networks and Where to Start

Authored by Brent T. Feorene, MBA, Vice President, Integrative Delivery Models

Why Preferred Post-Acute Networks?

Health system leaders recognize that one key to success for health systems and accountable care organizations (ACOs) in today’s value-driven environment is highly effective post-acute services and programs that are well-integrated into the care continuum. To be successful in bundled payments, the ACO environment, and the new outcomes-driven reimbursement arrangements, health systems must maximize the impact of the post-acute continuum for the benefit of patients and their own financial health.

The results of the Premier Spring 2016 Survey of system leaders indicate that over the next three years expanding and integrating high-value post-acute care networks is a key strategy for 95 percent of surveyed executives. However, the survey also indicates 94 percent of these executives feel that creating preferred post-acute care networks will likely be one of their greatest challenges in that same time period.

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CMS Announces BPCI Initiative Will Extend to 2018

Authored by Kristine A. Schaan, M.A., CPG, NHA, Consultant

The Centers for Medicare & Medicaid Services (CMS) recently released a statement that the Bundled Payments for Care Improvement (BPCI) initiative will extend to September 30, 2018 for Models 2, 3, and 4 episode initiators. Awardees that began participation in October 2013 as well as those awardees that joined in 2014 have the opportunity to extend their participation by two years, into 2018, as opposed to the scheduled end date of September 30, 2016.

The voluntary program is part of CMS’s broader initiatives through the its Innovation Center which tests innovative payment and service delivery models with the goal of achieving the Triple Aim. CMS hopes that extending BPCI will provide more time to evaluate and determine the initiative’s effectiveness.  “By extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending healthcare dollars more wisely,” Dr. Patrick Conway, CMS Acting Principal Deputy Administrator. Early insights by industry experts believe that many existing awardees will pursue extending their participation in the BPCI Initiative as a number of the frustrated awardees have already terminated their participation.

Link to CMS Fact Sheet: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-18.html

   
 
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