Bradley N. Shiverick. Senior Vice President Healthcare Analytics. Office cell

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1 Bradley N. Shiverick Senior Vice President Healthcare Analytics Office cell Need Help? [Toll Free]

Analytics bshiverick@teamtsi.com Office 256.

2 Agenda Five Star Rating System Overview February Changes and Implications Ensuring Accurate Information and Maintaining Ratings Excellence (Best Practices) Focused MDS Survey Process Preparation Survey Process Possible Outcomes 2

Maintaining Ratings Excellence (Best Practices) Focused

3 Five Star Overview Free Customer Training

4 CMS Five Star Rating 4

5 CMS Five Star Rating Survey Outcome Star Rating 1 5 stars State Specific Staffing Star Rating Combination of RN Staffing and Overall Staffing 4 5 Stars Add 1 to Survey 1 Star Subtract 1 from Survey Quality Measure Rating Combination of 11 Quality Measures 5 Stars Add 1 1 Star Subtract 1 * 1 Star, Maximum 2 overall. 5

Add 1 to Survey 1 Star Subtract 1 from Survey Quality Measure Rating

6 CMS Five Star Rating Five Star Rating Staffing Star Rating QM Star Rating 1 5 Stars 1 Star Subtract Stars Add 1 1 Star Subtract 1 5 Stars Add 1 6

7 CMS Five Star Rating What happened in February? Added Antipsychotic Measures Rebased the Quality Cut Points Adjusted the Scoring Grid 7

8 CMS Five Star Rating What happened in February? 8

9 CMS Five Star Rating What happened in February? 9

10 Survey Star Calculation Points for each FTag Weighted by cycle 50% Cycle % Cycle % Cycle 3 Cut points vary by state Penalty for revisits 10

11 CMS Five Star Rating Survey Points Calculation 11

12 CMS Five Star Rating State Level Cut Points 12

13 CMS Five Star Rating Survey Points Calculation Current Survey 50% Prior Survey 33.3% Prior (2) Survey 16.7% Complaints 12 Months 50% 25 Months 33.3% 36 Months 16.7% 13

14 CMS Five Star Rating An Example 4 D Level 2 E Level 1 G Level 14

15 CMS Five Star Rating An Example 4 D 4 Points 2 E 8 Points 1 G 20 Points 52 Points 15

16 CMS Five Star Rating What happens if we were surveyed tomorrow? Current survey becomes prior Prior survey becomes (2) prior Complaints don t change (yet) 16

17 CMS Five Star Rating What happens if we were surveyed tomorrow? Current survey 52 points (26) Prior survey 52 points (17) Prior (2) Survey 12 Points (2) Complaint (12) -24 Points (12) 17

18 CMS Five Star Rating What happens if we were surveyed tomorrow? New Survey -? Prior survey 52 points (17) Prior (2) Survey 52 Points (8.7) 18 Complaint (12) -24 Points (12) Total 37.7 Points Target 42 Goal = 9

19 CMS Five Star Rating What happens if we were surveyed tomorrow? New Survey 9 (4.5) Prior survey 52 points (17) Prior (2) Survey 52 Points (8.7) 19 Complaint (12) -24 Points (12) Total 37.7 Points Target - 42 Goal = 9

20 Staffing Rating Calculation RN PPD Overall PPD Per CMS-671 Case Mix Adjustment 20

21 CMS Five Star Rating Ensuring Accurate Results Form

22 Staffing Rating Calculation An Example 22

23 Staffing Rating Calculation An Example RN PPD 0.52 Total Nursing PPD 2.82 Case Mix Adjustment RN PPD 0.52 (0.645) Total Nursing PPD 2.82 (0.99)

24 Staffing Rating Calculation Case Mix Adjustment 24

25 Quality Rating Calculation State Level Cut Points 25

26 Quality Measure Rating 11 Quality Measures Each Rated is good 26 <= Star <= Stars <= Stars <= Stars >= Stars Residents Experiencing One or More Falls with Major Injury Residents Who Self Report Moderate to Severe Pain High Risk Residents With Pressure Ulcers Residents With a Urinary Tract Infection Residents Who Have/Had a Catheter Inserted and Left in Their Bladder Residents Who Were Physically Restrained Residents Whose Need for Help with Activities of Daily Living Has Increased Residents Who Self Report Moderate to Severe Pain Residents With Pressure Ulcers That Are New or Worsened Residents Who Received Antipsychotic Medications Residents Who Newly Receive Antipsychotic Medications

27 CMS Five Star Rating Five Star Rating Staffing Star Rating QM Star Rating 1 5 Stars 1 Star Subtract Stars Add 1 1 Star Subtract 1 5 Stars Add 1 27

28 CMS Five Star Rating Ensuring Accurate Results Survey Star Rating Team TSI Five Star Improvement Report calculates a target score for improvement. Have a good survey! 28

29 CMS Five Star Rating Ensuring Accurate Results Staff Rating Understand CMI Adjustment 60% RN 90% Overall Understand Form 671 Appropriately record all hours 29

30 CMS Five Star Rating Ensuring Accurate Results Form

31 CMS Five Star Rating Maximizing Results Form

32 CMS Five Star Rating Maximizing Results Form

33 CMS Five Star Rating Maximizing Results 33 Counts as RN time F39 Director of Nursing 80 hours? F40 Administrative Duties MDSC as LPN? F41 RN Regional or consultant Private Duty? Counts as Staff time All of the above F42 F45 Remember Contract Hours Private duty?

34 CMS Five Star Rating Ensuring Accurate Results Quality Measure Rating Process Measures Restraints, Catheter Assessment Measures Pain (2), UTI 34

35 CMS Five Star Rating Maximizing Results Five Star Prospective Report 35

36 Overview of Focused MDS Surveys (FMS)

37 Focused MDS Surveys 37 CMS Piloted a short-term focused MDS Survey Piloted in 5 states 5 nursing homes in each of the five states (25 total facilities) Citations were issued in 24 of the 25 nursing homes 2014 pilot citation results included; inaccurate staging & documentation of PU, lack of knowledge regarding classification of

38 Focused MDS Surveys 38 Driving force behind FMS OIG Study (37% stays - care plan, 31% stays - discharge plan. req., 47% med record didn t match MDS) Nursing Home Compare Media Scrutiny Currently expanding nationwide A minimum of 2 surveyors per FMS survey, one must be an RN. Estimated 2 days in facility, depending on size

39 Focused MDS Surveys 39

40 Focused MDS Surveys Surveyors will be required to complete a new post FMS survey questionnaire about the process and findings CMS staff to determine internally which facilities are to be surveyed in each state 40

41 Focused MDS Surveys Goal of the FMS: Assess MDS coding practices and its relationship to resident care Enhance surveyors ability to identify errors and citations related to MDS coding practices & resident care Assessment of the staffing levels and determine data that is self-reported on the CMS Form 671 Identify changes in the staffing levels throughout the year 41

42 Focused MDS Surveys Goal of the FMS: Compliance with the regulatory requirements for nurse assessment coordination Timeliness of assessments, and compliance with regards to initiating a Significant Change in Status Assessment Matching information found in the MDS 3.0 and the resident s medical record, using a series of worksheets and, in some cases, resident and staff interviews (CMS, 2015) 42

43 Focused MDS Surveys Focused MDS Survey Process Review records, supplemented by resident observations Staff & resident interviews, related to staff levels, care or other areas used to validate MDS coding consistency & staffing levels. Will conduct staff level interviews in regards to MDS coding practices and staffing. Be aware of what MDS tools you are using and know what they are looking for 43

44 Focused MDS Surveys Provide to Surveyors Staffing related to MDS, Quality Assurance Layout of Facility Policies and procedures related to MDS and Quality Assurance 10 most recently completed MDSs Correction requests Medical records to support the coding 44

45 Focused MDS Surveys Provide to Surveyors Focused Survey Facility Worksheet Pressure Ulcer Catheter Restraints UTI Falls Falls w/ Major Injury 45

46 Based Upon Pilot Citation Results 46

47 Overview of Findings Care Area % with Discrepency Falls with Injury 25.8% Stage of PU 18.3% UTI 17.6% Restraints 17.0% Neurogenic bladder Dx 15.9% Late Loss ADLs 15.4% 47

48 Additional Findings Higher Potential S/S 5.0% failure of the facility staff to accurately reflect the resident s status related to the use of antipsychotic medications 0.8% failure of facility staff to accurately reflect the resident s status related to the presence of an indwelling catheter 48

49 Team TSI Tools 49

50 Team TSI Tools 50

51 Team TSI Tools 51

52 M PU If PU healed during the look-back period & was not present on the prior assessment, code 0 If a resident who has a pressure ulcer is hospitalized and returns with that pressure ulcer at the same stage, the PU SHOULD NOT be coded as present on admission because it was present at the facility prior to the hospitalization If a current PU worsens to a higher stage during a hospitalization, should be coded at the higher stage upon reentry and SHOULD BE coded as present on admission Pages to review in RAI; M-5 Coding Tips M-8 Stage I (MO300A) & M-9 Stage II (MO300B) M-11 Stage III (MO300C) & M-13 Stage IV (MO300D) M-15, M-17, M-19 (Un-stageable) 52

53 N0410A - Antipsychotic 53 Record the # of days an AS med was received by resident at ANY time during the 7 day look-back period (or since admission/entry or re-entry if less than 7 days) Page N-5 Code a medication even if it was only given 1 time during the look back period Code meds in N0410 according to the med therapeutic category or pharm classification, NOT how it is used (PO, IM, IV) and in any

54 PO100 Physical Restraints 54 Any manual method, physical, mechanical device, material, equipment attached or adjacent to the resident s body in which the resident can t easily remove which restricts freedom of movement or normal routine access to their body. (SOM App PP, P-1 MDS RAI) also review P-3 RAI Coding Practices on MDS (7 day look-back period) Code 0, not used Code 1, used less than daily Code 2, used on a daily basis Important to classifying any physical restraint as to the consideration of the effect it has on the resident, not the purpose or intent of the PR s use, keep in mind that a PR may improve a resident s mobility but also have the effect of physically restraining them. Exclude any items that are typically used in the provision of providing medical care (catheters, drainage tubes, casts, traction, braces, adom. binders/bandages) P-5 RAI

55 Thank you! Questions & Answers Please type any questions into the GoToTraining control panel

56 Bradley N. Shiverick Senior Vice President Healthcare Analytics Office cell Need Help? [Toll Free]

Objectives. Objectives. The Facility Compliance Program Handbook 3/11/2016. Training 1

Objectives. Objectives. The Facility Compliance Program Handbook 3/11/2016. Training 1 Understanding the Five Star Quality Rating System Design For Nursing Home Compare Nathan Shaw RN, BSN, MBA, LHRM, RAC CT 3.0 Director of Clinical Reimbursement March 23rd, 2015 Objectives Objectives Provide