Five-Star Quality Rating System and Improvement Methods: CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily..
The Five Star is based on three domains: Health Inspections, Staffing and Quality Measures. The Five-Star Quality Rating System is the primary indicator of a facility’s ability to deliver quality care to its resident population and is playing a role in provider contracts and pay for performance. Most facilities can only impact a change to their overall Five-Star between annual surveys by carefully focusing on their Five-Star Quality Measures, which can be challenging to interpret due to the variation in ranges for each individual Quality Measure, of which there are currently eleven.
How can Harmony Healthcare International (HHI) help?
Harmony Healthcare International (HHI) can assist with the following:
- Assist in identifying positive and negative trends to improve quality of care and accurate and appropriate reimbursement
- Provide a visual representation of how Quality Measures compute into your Five-Star Rating
- Evaluate quality measures against national benchmarks and identify areas of opportunity
- Verify the accuracy of MDS coding items that triggered each quality measure
- Education and training regarding Five-Star Quality Rating System
- Assist with the adoption of new Quality Measures that will be incorporated into the Five-Star Rating system
Quality Measures: There is a heightened focus on Nursing Home quality and safety since the Affordable Care Act (ACA) was passed in March 2010. The Centers for Medicare and Medicaid Services (CMS) released a five-part action plan with a three-part aim focused on improving individuals’ perception of care, humanizing the health of populations, and reducing the per capita cost of care. As a result, Nursing Homes must focus on the task of providing high-quality care in the most cost-effective manner possible.
One method for determining the quality of care in a Nursing Home is using Quality Measures. These measures, which are derived solely from MDS (Minimum Data Set) data, are available to each facility through the MDS login page of the QIES ASAP. At their fingertips, facilities have the MDS 3.0 Facility Level Quality Measure Report, (aka the CASPER report), updated regularly based on submitted MDS's. However, the CMS Nursing Home Compare website is used to predict a facility's ability to deliver high quality care. These results are essential for care oversight, census management and revenue insulation.
This analysis is a pivotal predictor for operational success. Two resident samples are selected for computing the Quality Measures:
- Short Stay sample
- Long Stay sample
The objective of this engagement is to ensure the documentation on the submitted MDS's reflect the accurate assignment of wound type, stage, location and time the wound developed based on facility specific supporting medical record documentation. Harmony Healthcare International (HHI) will:
- Obtain and review the MDS 3.0 Facility Level Quality Measure Report, aka the CASPER report, with data compiled from the six months leading into the most recent Nursing Home Compare Five-Star Rating calculation.
- Obtain and review facility specific Policies and Procedures related to Skin Care, Wound Team rounds, Nursing Documentation or any other Policy that may related to subject of audit.
- Identify specific Residents (sample) and their submitted MDS types that populated the measures numerator and denominator.
- Perform an independent, focused review of each patient's medical record documentation to support and correspond with findings reported on the MDS to ensure reporting accuracy.
- Identify of trends as well as gaps in current facility-based, internal processes and systems.
- Provide clinical breakdown and identification of QM trigger based on both of the Pressure Ulcer Short Stay and Long Stay Quality Measure technical guidelines.
- Create facility specific recommendations, action plans and/or performance improvement plans to proactively correct information that was found to be out of compliance while implementing systems to ensure ongoing compliance related to the identification of patients at risk for pressure ulcers and the care of their needs moving forward.
Harmony Healthcare International (HHI) will prepare a report for the Compliance Officer at the end of the audit and provide an opportunity for report finding discussion scheduled between the two parties.