Quality Measure Audit

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, improving the health of populations, and reducing the per capita cost of care for populations. Nursing homes are charged with the task of providing high-quality care in the most cost effective manner possible. Quality measures, which are derived solely from MDS data, are available to each facility through the MDS login page of the QIES ASAP website. Because Quality Measures are 100% comprised of MDS data there is a high risk for error if staff members coding the MDS do not know the guidance for coding each section. Many staff members responsible for coding these sections do not realize that the information they are coding is used to contribute to the calculation of the facility Quality Measures. The Quality Measures represent a core set of performance measures for chronic and post-acute care nursing facilities which provide tools for regulators, purchasers, and consumers to evaluate the quality of care in these facilities, as well as metrics that facility staff can use to assess and improve the quality of care they provide. These measures evaluate the resident’s physical and clinical conditions and abilities.

How can Harmony Healthcare International, Inc. (HHI) help?

  • Review of MDS assessments, coding and documentation practices that contribute to Quality measure outcomes
  • Complete medical record reviews for residents that flag on particular quality measures 
  • Assist with preparation for adoption of new Quality Measures that will be incorporated in the Five-Star Rating Quality Rating System
  • Establish a quality assurance performance improvement system to assist the facility with management and improvement of quality measure outcomes, root cause analysis, etc. Consulted:  Who are the subject matter experts who are to be consulted? (Stakeholders)
  • Establish an audit process to ensure MDS accuracy and to ensure that documentation in the medical record supports RAI criteria is critical. Provide training and education to staff on Quality Measures, analysis of those which trigger
  • Provide an overview of MDS Focused Survey as it relates to Quality Measures
  • Assist with staff education and training on Quality Measures, MDS coding, ADL’s, etc.

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