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CMS Nursing Home Compare Adds Six New Quality Measures: Upcoming Changes to the Calculation of the Nursing Home Five-Star Quality Ratings

April 28, 2016

On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its Nursing Home Compare website. The six new quality measures are the largest addition of quality measures to the Nursing Home Compare website since 2003, and include four short-stay measures and two long-stay measures. The measures are:

Short-Stay Measures:

  • Percentage of short-stay residents who made improvement in function (MDS-based)
  • Percentage of short-stay residents who were successfully discharged to the community (Claims-based)
  • Percentage of short-stay residents who were rehospitalized after a nursing home admission (Claims-based)
  • Percentage of short-stay residents who had an outpatient emergency department visit (Claims-based)

Long-Stay Measures:

  • Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
  • Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based)

CMS will incorporate these new measures into the calculation of the Nursing Home Five-Star Quality Ratings, with the exception of the long-stay antianxiety or hypnotic medication measure, beginning July 2016. CMS has stated that it will delay including the antianxiety or hypnotic medication measure until it can determine appropriate nursing home benchmarks for the acceptable use of these medications.

Key Takeaways:

For the first time, CMS is now including quality measures that are not based solely on data that was self-reported from nursing facilities. Three of the new short-stay quality measures include evaluations of the rate of rehospitalization, emergency room use, and community discharge among nursing home residents, and will be based on Medicare-claims data submitted by hospitals. In order to respond to these new quality metrics, nursing homes should ensure that the appropriate communication channels with local hospitals are in place to foster efficient coordination of residents between nursing homes and hospitals, as well as the timely submission of Minimum Data Set (MDS) forms and claims.

With the release of the new quality measures, CMS has also practically doubled the number of short-stay measures. These measures evaluate care provided to residents who reside in a nursing facility for 100 days or less. The new measures also reflect CMS’s effort to provide information about significant short-stay outcomes, such as the percentage of residents successfully discharged and the rate of improvement with activities of daily life (ADL). In light of the new increase in short-stay measures, nursing homes should work to support the needs of and enhance the performance outcomes of its short-stay population.

In addition, the new short-stay measures include measurements of outcomes after discharge from nursing homes. As a consequence of the new quality measures, nursing homes will also have to reevaluate the traditional discharge planning process and work to pursue inventive strategies in order to achieve improved performance outcomes.

Conclusion

CMS uses the information obtained from its quality measures to evaluate the quality of certain aspects of nursing home care, and to calculate ratings for nursing homes. Not only do the ratings provide valuable information to residents and their families, but the ratings also serve to allow nursing homes to use the quality measures to evaluate, analyze, and improve the quality of care provided to residents. The addition of these new quality measures will require nursing homes to review the care provided and devise new processes and systems to improve performance outcomes.

If you have any questions about these new quality measures or need assistance in implementing changes to your organization in response to these new measures, please contact a member of HDJN’s Long-Term Care & Post-Acute Care team.

Authored By:

Megan K. Dhillon
Megan K. Dhillon

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel, Johnson & Nagle, PC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel, Johnson & Nagle, PC be liable for any direct, indirect, or consequential damages resulting from the use of this material.