Harmony Healthcare Blog

SNF Quality Reporting Program (SNF QRP): Top 10 Things you Need to Know

Posted by Sally Fecto on Mon, Oct 15, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Future on Pocket Watch Face with Close View of Watch Mechanism. Time Concept. Vintage Effect.Skilled Nursing Facilities are faced with a multitude of changes over the next decade.  Regulatory and survey expectations require immediate attention and staff training. 

In addition, the advent of quality reporting complicates matters and the following blog is intended to help clarify the mystique and criteria for payment and submission.  Here are the Top 10 things you need to know about SNF QRP. 

  1. The SNF Quality Reporting (SNF QRP) will expand with the updated October 1, 2018 MDS. The Fiscal Year (FY) 2020 program is based on four quarters of data from 1/1/2018 through 12/31/2018.  
  2. Starting October 1, 2019 (FY 2020) the facility’s Annual Payment Update (APU) will be updated based on the compliance determination from data submitted for admissions to the SNF on and after January 1, 2018 and discharges from the SNF up to and including December 31, 2018. You, the SNF Provider, are in the data collection period, now.

    The data collection period and data submission deadlines affecting the FY 2020 Payment Determination are as follows: 

Data Collection and Submission
for

Quarterly Review, Correction Periods and Data Submission Quarterly Deadlines
for

The Quarterly Reporting Period

Payment Determination

CY Q1:     January 1st through

                  March 31st

Q1 Deadline: August 15th

CY Q2:     April 1st through

                  June 30th

Q2 Deadline: November 15th

CY Q3:     July 1st through

                  September 30th

Q3 Deadline: February 15th

CY Q4:     October 1st through

                  December 31st

Q4 Deadline: May 15th

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  1.  There are 9 Assessment-Based Quality Measures Currently Adopted for the FY 2020 SNF QRP: 

Quality Measure

Measure (Assessment-Based)

Pressure Ulcers That Are New or Worsened (Short-Stay)
(NQF #0678)

Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short-Stay) (NQF #0678) This measure will be replaced with the Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury measure, effective October 1, 2018.

Changes in Skin Integrity

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

Functional Assessment and a Care Plan that Addresses Function (NQF #2631)

Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function (NQF #2631).

One or More Falls with Major Injury (Long-Stay) (NQF #0674)

Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) (NQF #0674).

Drug Regimen Review

Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP- Data collection begins October 1, 2018.

Change in Self-Care
(NQF #2633)

Application of IRF Functional Outcome Measure: Change in Self-Care for Medical Rehabilitation Patients (NQF #2633) – Data collection begins October 1, 2018.

Change in Mobility Score (NQF #2634)

Application of IRF Functional Outcome Measure: Change in Mobility Score for Medical Rehabilitation Patients
(NQF #2634) – Data collection begins October 1, 2018.

Discharge Self-Care Score (NQF #2635)

Application of IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635) – Data collection begins
October 1, 2018.

Discharge Mobility Score (NQF #2636)

Application of IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636) – Data collection begins
October 1, 2018.

 

  1. There are 3 Claims-Based Quality Measures Currently Adopted for the FY 2020 SNF QRP Measure:

Discharge to Community

 

Discharge to Community – Post-Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

Potentially Preventable 30-Days Post-Discharge Readmission

 

Potentially Preventable 30-Days Post-Discharge Readmission Measure for Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

Medicare Spending Per Beneficiary (MSPB)

 

Medicare Spending Per Beneficiary (MSPB) – Post-Acute Care (PAC) Skilled Nursing Facility Measure

 
The above measures will be calculated using Medicare FFS Claims and therefore no additional data collection is required by the provider. The SNF QRP Quality Measure Reports are expected to be publicly posted in the Fall of 2018. 

  1. The Assessment Based Functional Outcome Quality Measure for Mobility and Self-Care is calculated from the admission Mobility and Self-Care scores using the admission and discharge codes, with some additional criteria. This measure requires risk-adjusted data for the Review and Correct Reports since it estimates the percent of residents who meet or exceed an expected discharge self-care score. 
  2. The Mobility Assessment items used for admission Mobility score calculations are: 
    1. Roll left and right
    2. Sit to lying
    3. Lying to sitting on side of bed
    4. Sit to stand
    5. Chair/bed-to-chair transfer
    6. Toilet transfer
    7. Car transfer
    8. Walk 10 feet
    9. Walk 50 feet with two turns
    10. Walk 150 feet
    11. Walking 10 feet on uneven surfaces
    12. 1 step (curb)
    13. GG0170N1 4 steps
    14. GG0170O1 12 steps.
    15. Picking up object 

Valid codes and code definitions for the coding of the admission Mobility items are: 

  • 06 – Independent
  • 05 – Setup or clean-up assistance
  • 04 – Supervision or touching assistance
  • 03 – Partial/moderate assistance
  • 02 – Substantial/maximal assistance
  • 01 – Dependent
     
  • New Call-to-action
  • 07 – Patient refused
  • 09 – Not applicable
  • 10 – Not attempted due to environmental limitations
  • 88 – Not attempted due to medical condition or safety concerns
  • ^ – Skip pattern
  • – –  Not assessed/no information 

To obtain the Score:  

  • If code is between 01 and 06, then use code as the score for each Mobility item.
  • If code is 07, 09, 10, or 88, then recode to 01 and use this code as the score for the Mobility Item.
  • If the mobility item is skipped (^), dashed (-), or missing, recode to 01 and use this code as the score.

Sum the scores of the admission mobility items to create an admission mobility score for each resident stay. Scores can range from 15 – 90, with a higher score indicating greater independence.

Calculate the admission Self-Care Score by using the admission Self-Care Score items and valid codes as identified below: 

  1. The Self-Care Assessment items used for Admission Self-Care Score Calculations are:
    1. Eating
    2. Oral Hygiene
    3. Toileting Hygiene
    4. Shower/Bathe Self
    5. Upper Body Dressing
    6. Lower Body Dressing
    7. Putting on/taking off Footwear
  2. Sum the Scores of the admission self-care items to create an admission self-care score for each stay-level record. 
  • Scores can range from 7 to 42, with a higher score indicating greater independence

Calculate the discharge Self-Care score using the discharge Self-Care score items and valid codes, for the same self-care areas as the admission items. 

A resident is excluded if any of the following are true:  

1. Resident has an incomplete stay: 

  • Length of stay is less than 3 days: Discharge Date – Admission Date is less than 3 days.
  • Resident discharged against medical advice (AMA).
  • Resident died while in facility.
  • Medical Emergency: Patient’s discharge destination: Short-term General Hospital, Long-Term Care Hospital (LTCH), Inpatient Psychiatric Facility, Critical Access Hospital
  • Patents discharged directly to another IRF: Another Inpatient Rehabilitation Facility. 

2.  The resident is independent with all self-care and/or mobility activities at the time of admission.

  1. The Functional Outcome Quality Measure iscalculated by observing the change in self-care and mobility scores for each resident stay-level record. For each stay-level record included in the target period, subtract the admission self-care or mobility score from the discharge self-care or mobility score. If a patient’s self-care score decreased from admission to discharge, the difference will be a negative value.
  2. Drug Regimen Review Conducted with Follow-Up for Identified Issues
    Data Collection beginning October 1, 2018.

    The denominator is the number of stays in the selected time window for SNF residents with a SNF PPS Part A Discharge Assessment (A0310H = 1) during the reporting period.  Specific denominator definitions for each setting are provided below.

    The numerator is the number of stays in the denominator where the medical record contains documentation of a drug regimen review conducted at admission with all potential clinically significant medication issues identified during care and followed-up with a physician or physician designee. The numerator is the number of short-stay residents with an MDS 3.0 assessment during the selected time window for which all the following are each true: 
          1. The facility conducted a drug regimen review at the admission (N2001= [0,1]) or resident is not taking any medications (N2001= [9]); and
          2. If potential clinically significant medication issues were identified at the admission (N2001 = [1]), then the facility contacted a physician (or physician-designee) by midnight of the next calendar day and completed prescribed/recommended actions in response to the identified issues (N2003= [1]); and
          3. The facility contacted a physician (or physician-designee) and completed prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission (N2005 = [1]) or no potential clinically significant medications issues were identified since the admission (N2005 = [9]). This condition is evaluated at discharge. 

Interested in learning more? Join us at harmony18, our 7th annual interdisciplinary LTPAC symposium.  This year’s symposium features former NFL and Super Bowl player, Joe Andruzzi; Inspirational Charity Founder, Ellie Anbinder; AHCA Sr. VP, Dr. David Gifford; an entire panel on PDPM; and more!  10 continuing education hours for all disciplines.  November 1-2, 2018 at Mohegan Sun Resort and Casino.

Click Here to Register. Room block expires early October. 

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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