Harmony Healthcare Blog

Quality Measure Confusion and Clarity: Hospital Readmissions

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Mar 17, 2017

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Edited by Kris Mastrangelo


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

confused.jpgThis blog will be short. It is meant to give you an “aha” moment. 

It has been one heck of a ride these last three years. We keep studying, we keep reading and we keep pulling “all-nighters” just to keep abreast of the nonstop regulatory and reimbursement changes.  I have whiplash from the dinging, pinging and buzzing on my multiple devices. The days are consumed with massive amounts of questions and discussions from top level CEO’s, Executives, and Clinical Management Teams across the country all with a unified goal of deciphering and simplifying Value Based Purchasing (VBP), Bundled Payments and the Quality Reporting Program (QRP). 

But what does it all mean? Last August, the self-proclaimed “Harmony Road Warriors” convened in the Harmony University think tank. We pondered the changes and conversation ensued on the various formulas, deadlines, data collection periods, and, of course, the ultimate implementation date.  The more we dialogued, the more we imploded.  Finally, it seemed that there were multiple interpretations of the definition of the Hospital Readmission Quality Measure. But then, I uncovered, that it was not  three varying impressions, it was actually three distinct Quality Measures on Hospitals Readmissions! 

What? This was so simple but yet so taxing on our brains! How could there be multiple Quality Measures for the same item with different calculations? Sit tight and let me explain. 

The three Quality Measures with three different calculations for Hospital Readmissions include:  

  1. Five-Star Quality Measure (Nursing Home Compare)
  2. Value Based Purchasing (VBP)
  3. Quality Reporting Program (QRP) 
How do they differ?

Five-Star Quality Measure (Nursing Home Compare)
  • Calculation includes Observation Stays 

Value Based Purchasing (VBP) 

  • Calculation does not include Observation Stays
  • Hospital Readmissions defined as “All Cause”
  • Known as the SNFRM (Skilled Nursing Facility Readmission Measure) 

Quality Reporting Program (QRP) 

  • Calculation does not include Observation Stays
  • Hospital Readmissions defined as “Potentially Preventable”
  • Known as the SNFPPR (Skilled Nursing Facility Preventable Readmissions) Measure 

While there are more details on each of the three calculations (which we will certainly define in future blogs), Step One is understanding that they exist and that they are different.    Step two is knowing that SNFRM will ultimately become the SNFPPR Measure.

In closing, I would like to share with you one of the Harmony Healthcare International (HHI) Secret Tools developed at the infamous August 2016 gathering.  The Harmony Healthcare International (HHI) Quality Measure Grid provides you with an Overview of the 43 Quality Measures, the data source and the purpose of each.

Download HHI's Quality Measures Grid

Need additional training or a better understanding of Quality Measures, especially in regards to pain?  Join us for our upcoming MDS Competency Courses (CHHi-MDS).  Click here to see the dates and locations.

Join us November 2nd & 3rd, 2017 at Foxwoods Resort for harmony17
6th Annual LTPAC Symposium
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harmony20 October 29-30 2020 Encore Boston Harbor

Tags: Quality Measures, rehospitalizations, hospital readmissions

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