The fate of your stars: CMS and the new quality measures

Tired of quality measures and ratings? Brace yourself for even more, said Cynthia Morton, MPA, Executive Vice President of the National Association for the Support of Long Term Care (NASL), in the opening keynote at the Memory Care Forum in Philadelphia.

The Centers for Medicare & Medicaid Services (CMS) announced the addition of six new quality measures in April, and more are on the way as the healthcare reimbursement system continues to move away from fee for service and toward payment for quality models, says Morton, who has spent decades as a post-acute care policy expert and congressional policy lobbyist.

“We’re going to be quality-measured to death,” she says, but it's all about proving value of the care being delivered. “Before, we delivered a service and sent a bill. No one really looked at whether that care was worth it.”

Now, everyone’s eyes are on the prize of lower cost and higher quality. The goal is to reach a 30 percent ratio of value-based reimbursement by the end of 2016, and a full 50 percent ratio by the end of 2018. All entities from CMS to MedPAC are seeking measurable, trackable data to prove that care services are worth what they cost to deliver.

The next measurement challenges

Most nursing homes are accustomed to the emphasis placed on reducing unnecessary hospitalizations. That isn’t going away anytime soon, Morton says. “Everything is going to be about rehospitalizations in the next five to 10 years, so change your processes so you can sustain your improved hospitalization rates over the long term.”

The next two big measures will be emergency department utilization and discharge-to-community processes, primarily because “CMS doesn’t need to add anything to the MDS to track those,” Morton says.  

Then there’s payroll-based journal (PBJ) reporting, a staff hours and payroll reporting system whose mandated compliance is slated to begin July 1 and which Morton predicts will be a bit of a mess. “We weren’t quite good enough at self-reporting our staff the way we had been doing it, so now we’ll have to prove it.”

The impact of the IMPACT Act

The IMPACT Act, passed by Congress in 2014, is all about post-acute care, including all segments from long-term care to rehabilitation and long-term care hospitals. Its two main goals are data standardization and data interoperability, two topics housed firmly in the information technology (IT) department. But accomplishing these goals includes plenty of changes all the way down the line right to the nursing staff at the resident’s side, with new ways of charting data, entering data and even naming data.

Apples and oranges

One of the biggest complaints from skilled nursing facilities (SNFs) is that the CMS quality measures don’t take the resident population acuity into account—in other words, caring for the most challenging residents doesn’t pay any more than caring for residents with average needs. “Right now, CMS doesn’t discern allow SNFs to express what they specialize in,” Morton says. “They don’t adjust for acuity and don’t account for special populations like ventilation therapy or wound care centers. Maybe that will be changing sometime soon.”

Another hint: Collaboration is definitely the future, especially among post-acute care, acute care, physicians and specialty services, Morton says. Preventing unneeded visits to the emergency room involves everything from medication reviews to falls prevention, and the more clinicians work together across care settings the better, she says.

What else is coming

Therapy caps: Expect plenty more arguing over what to do about therapy caps, Morton says. “The idea of therapy caps is so anti-patient, but will we ever get rid of them? I don’t know.”

SNF Part A: Get ready to shake out those RUGs. The Resource Utilization Groups we know so well may get a serious overhaul in the near future, especially the ones related to therapy, Morton says. “How do the payers know if therapy is doing any good? We need a way to show the value of the therapy we’re providing.”

Assisted living: Yes, you just might be next. Most of the assisted living market has been accustomed to focusing on regulations applied by their individual states, but there are those who think standards should be applied at the federal level. “Congress would love to get their hands on assisted living,” Morton warns.

The Philadelphia Memory Care Forum is hosted by the Institute for the Advancement of Senior Care (IASC) and Long-Term Living magazine. To learn more, visit the IASC Memory Care Forum page.

Topics: Alzheimer's/Dementia , Articles , Medicare/Medicaid , Regulatory Compliance