Data = Quality

Today more ever, data is being collected and used in a transparent manner to prove quantity and quality of care.  In order to remain viable in the marketplace, SNFs will need to be able to collect accurate data, be able to analyze data and adjust organizational practice and process based on objective data to continuously quality.

Yesterday’s CMS Open Door Forum (3/3/2016) provided enlightening information on several key areas:

  • Quality Measures (QMs):As of April 2016, CMS will be posting data for thesix new QMs on Nursing home compare.  In July, 2016, 5 of the 6 measures will be included in the Five-Star calculations for Nursing Homes.
    • Those sixQMs include three (3) claims based measures and three (3) MDS based measures. These changes increase the number of short stay measures on Nursing Home Compare.  All of these short stay measures include Medicare Fee for Service Beneficiaries.
    • Short-Stay Measures include:
      • Percentage of short-stay residents who were successfully discharged to the community.
      • Percentage of short-stay residents who have had an outpatient emergency department visit.
      • Percentage of short-stay residents who were re-hospitalized after a nursing home admission.
      • Percentage of short-stay residents who made improvements in function.
    • Long-Stay Measures include:
      • Percentage of long-stay residents whose ability to move independently worsened.
      • Percentage of long-stay residents who received an anti-anxiety or hypnotic medication (At this time, this measure will not be utilized in the Five-Star calculations).
    • Data from QMs for Short-Stay residents who were re-hospitalized after a nursing home admission will be included in the Medicare VBP Measure affecting reimbursement in October, 2017.

**You can access the CMS slides regarding the new QMs here. **

  • PBJ – Payroll Based Journal: OnJuly 1, 2016, SNFs are required to electronically submit staffing data to CMS. There are very specific definitions for each data field for the information to be submitted.
    • The data fields have to line up the CMS PBJ system in order for the data to be accepted.
    • Many electronic staffing software packages can produce the required reports for submission.
    • There is an option for manual input of staffing data.
    • We strongly encourage you to begin now and test your ability to successfully transmit the required information. Some facilities have reported difficulty, therefore it is recommended not to wait until the last minute to test the system.
    • Loelei Chapman reported during the CMS Open Door Forum Call, that information submitted during this voluntary submission time, will not be used for survey or for Five-Star.
    • If you have questions, please go to theirwebsiteor call the QTSO help desk.
  • SNF PPS Payment Models:CMS has contracted with Acumen for analysis of SNF PPS payment models.  Acumen has completed an analysis of therapy payment on the current PPS System.
    • The next phase is to examine opportunities for potential improvements to the overall SNF payment structure.
    • You can read the information on the CMS websitehere.
  • IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014):This Act will require the reporting of standardized assessment data across the Post-Acute Care Continuum (LTCHs, SNFs, HHAs and IRFs).
    • The first step is cross-cutting QMs that have been developed to collect consistent information across the Post-Acute Care entities.
    • These measures do not require additional steps for data submission.
    • Information for SNFs will be initially collected through the changes coming to the MDS 3.0 as ofOctober 1, 2016.

Post-Acute Care Leadership Tips:

There are several key operational strategies that organizations should consider now:

  1. Institute a system to ensure oversight of MDS coding accuracy.
  2. Put into place an evidence-based hospital readmission reduction program such as the INTERACT™ 4.0 Quality Improvement Program.
  3. Begin to test staffing information on the voluntary PBJ System in order to be able to troubleshoot any difficulties prior to the mandatory reporting.
  4. Watch for RAI Manual updates as it is recommended that staff are trained in the new Sections of the MDS 3.0, A and GG and M for preparation for accurate future coding.

It is important that organizations look at three key areas for future success: competency, clinical capacity and data management.

Continue to watch for more strategic tips for success as these initiatives continue to unfold in the near future.



Karolee Alexander

Director of Reimbursement

& Clinical Consulting



Susan LaGrange

Director of Education


Source: CMS Open Door Forum Call 3/3/16