QM Savvy in a QRP World

As an industry, PAC is heading toward a “one world” system. Universal Post-Acute Care, or UPAC is what this will be known as. The IMPACT Act has legislated that soon, LTACHs, IRFs, SNFs and HHs will all be driven by site neutral quality measurement and site neutral payment. The Quality Reporting Program has been materializing for some time and Both the PDPM for SNFs and the PDGM for HHs are the first foray in site neutral payment. Our world is surely changing.

The PDPM will adjust over time as CMS determines its course. However, we are currently faced with a quality reporting world that is still a sort of hybrid of the MDS based quality measures we have all come to know through CASPER, the Nursing Home Compare public reporting site and a mix of MDS based and claims based measures that are quickly transitioning to QRP as the standard. Providers need to have all of the resources necessary to remain up to date with what each measure. Here is a list to help you on your way. There have been plenty of updates lately so be sure you have the latest versions.

1.     Quality Measures – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures  In the downloads section of this site you will find a link to the most recent quality measures manuals. This download contains the measure specifications for the current QMs as well as the MDS and claims based QRP measures.

2.     Medicare Spending Per Beneficiary – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/2016_07_20_mspb_pac_ltch_irf_snf_measure_specs.pdf  This separate manual details the only claims based measure not found in any of the other QM manuals.

3.     Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/Downloads/SNFRM-TechReportSupp-2019-.pdf – This is another separate document that explains the technical specifications for the Hospital Readmission Measure that currently drives SNF VBP and your annual VBP payment adjustment.

4.     5-Star User’s Manual https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS   Updated in October 2019, this is the most current version of this manual. It is located in the downloads section of this site.

5.     IMPACT ACT websitehttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-of-2014-Data-Standardization-and-Cross-Setting-Measures  This website gives the background and helpful insight into the IMPACT ACT and the effect it will have on the PAC settings.

6.     SNF QRP https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information  This site contains everything QRP. It should be accessed regularly for updates. The downloads section contains change tables and other resources relative to current QRP revisions.

7.     SNF QRP Training https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training  Contains training resources related to SNF QRP. The latest update is a very helpful training video about IMPACT and QRP.

8.     SNF QRP FY 2021 Updates, Final Specifications for SNF QRP Quality Measures and Standardized Patient Assessment Data Elements (SPADEs) – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-Downloads-and-Videos  Find this document in In the downloads section of this site as well as a related change table showing the changes coming to MDS 3.0 v1.18.0.

9.      MDS 3.0 Technical Information – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation  Find the DRAFT version of MDS 3.0 v1.18.0 effective October 1, 2020.

I hope these links are helpful. There is much to assimilate. Do you have a challenging MDS, Reimbursement, QM or QRP question? Give us a shout at Ask the Expert. Broad River Rehab is a knowledgeable and compassionate partner, we would love to help.