Transcript OHCA Dist II Jan 2016x - Miami Valley Long Term Care

OHCA DISTRICT II
LTC UPDATE
Kenneth Daily, LNHA
[email protected]
District News
■ CEUs for today’s program is 2.0 hours
■ 2016 we will:
– Conduct the annual wage survey
– Solicit for semi-annual scholarships
– 50th Anniversary Celebration
Golf Outing
Annual
Golf Outing
Pipestone Golf Club
August 25th
Shotgun start @ 9AM
OHCA Events
■ OHCA Convention
May 2-5
■ February 3 - 5
EFOHCA -- Activity Professionals
Conference
■ February 16
EFOHCA -- Therapy Conference
Survey update from Region V
■ Nationwide focus on infection control (F441), falls and accidents (F323),
antipsychotics (F329) and quality of care (F309).
■ Ohio had lowest number of deficiencies in the Region, but the highest daily
fines in the Region.
■ CMS Region V imposed a higher amount of fine than SA recommended
38% of time.
■ MDS focused surveys ongoing. #1 cite is F278 for MDS accuracy. Nurse
staffing posting (F326) also frequently cited. Results count in your 5‐Star
Rating .
■ Dementia focused surveys will continue in 2016 and will no longer be
identified as a “complaint” but results will count in your 5‐Star Rating.
Focused Surveys
■ MDS focused survey is on-going through FFY 2017
■ Dementia focused survey is expected to begin with
surveyor training in Q1
■ Adverse event (medication errors) is expected to
begin in 2016
Final Rules
■ Life Safety Code – move to the 2012 code expected in Q1
– Increase inspection, testing and maintenance (ITM)
■ Emergency Preparedness final rule is expected in 2016
– Extensive rule with all-hazard approach and includes risk
analysis, communications, trainings and exercises
Federal Priorities
■ Re-hospitalization
■ Know your re-hospitalization rates
– Reduce re-hospitalizations to less than 10 -12%
– Review all of your rehospitalizations
– Assume 100% were preventable
– Develop robust transitions of care program
– Arrange follow-up and communicate with primary care MD
– Do follow-up calls to discharges to community within 24 hours
and 3-5 days later
5 Star Rating
■ Managed Care & ACOs use to establish networks
– CMS will waive 3 day hospital stay to qualify for SNF stay if SNF has 3 Star or
greater rating for
■
■
Hospitals in CCJR model (starting Jan 1st)
Hospitals in Advanced ACO demonstration
■ Adding measures in 2016
– Rehospitalizations, Discharge to community, Mobility in room for long stay
residents, hypnotics and Change in ADL from admission to discharge
■ IMPACT Measures
– Potentially preventable Re-hospitalization during and 30 days after SNF discharge
– Discharge back to community
– Drug regime review (poly pharmacy)
– Average cost per beneficiary during and after SNF discharge
Payroll-based Journal Entry
■ Staffing and Census data for feds voluntarily began 10/1/15
and will become MANDATORY July 1, 2016
– Determine level of staff in facilities
– Report on employee turnover and tenure
■ Referred to as Payroll-based Journal – PBJ it will allow
facilities to report the required category of work such as RN,
LPN, STNA, therapist, etc.
PBJ
Staffing Data Collection
■ Rule implements the staffing data collection; requires submission of
– Data submitted is similar to data submitted currently on
CMS 671 and CMS 672
– Category of work of both contract and direct employees
– Specify which employees are contract and direct
– Info on start and end date and hours worked (meeting the
statutory requirement for information on turnover and
retention
– Hours of care provided by each category of employees per
day
Staffing Data Collection
■ Submission will be quarterly
– Census Data Includes the facility’s census on the last day of each of the three
months in a quarter
■ Submission will be a Required
– Deadline for receiving the submissions is by the end of the 45th calendar
(11:59 PM Eastern Standard Time) after the last day in each fiscal quarter.
Methods of Submission
■ The PBJ system has been designed to accept two primary
submission methods
– Manual data entry - require an individual(s) at a facility
to key in information about employees, hours worked,
and census information directly into the PBJ User
Interface
– Uploaded data from an automated payroll or time and
attendance system which will function very similarly to
how MDS data are submitted currently
■ In addition, users can use both methods of these methods,
for submitting data as needed
Gathering Employee Information
■ Staff members in direct care positions
■ Contracted / Agency employees in roles identified by CMS
■ Medical Professionals
■ Gathering Staffing Hours (Daily)
– Manual Time Sheets & Excel Spread Sheet Tracking
– Calculation of worked hours
– Distribution of hours for direct vs indirect
– “Reasonable Methodology” for allocation across Service Lines
(AL, IL, SNF)
■ Time frames – should be daily to avoid memory issues
■ Auditable document TRAIL
Ohio Changes
■ Medicaid Rebasing
– Most significant revisions to pricing system since its creation in
2005
– Prices rebased using updated data
– New grouper for determining case mix
■ New quality incentive system (third since 2005)
■ Further reduction of PA1/PA2 rate
Rebasing - The Get
■ Existing law drives most changes - because reimbursement system is still in
statute
■ First increase in prices since SFY 2008 (prices declined SFY 2012)
■ End result is about 6.7% increase in rates ($12+ per day)
– 2017 increase estimated at $78 million, now $139 million
■ Average Rates by Peer Group
– Estimates based on what we know now:
■
■
■
■
■
■
Peer Group 1-L $194
Peer Group 1-S $195
Peer Group 2-L $191
Peer Group 2-S $195
Peer Group 3-L $177
Peer Group 3-S $180
RUGs IV
■ Statute allows ODM to decide which grouper will be used
■ After debate in legislature and discussion with provider
associations, ODM chose 57 group, hierarchical model of RUG IV
■ RUG IV results in higher direct care rates than if RUG III had been
retained
– Broader range of case mix scores under RUG IV than RUG III,
which in turn means a broader ranger of rates
■ SFY 2017 rate modeling so far uses historical case mix scores
created by reprocessing old MDS data
– Actual rates will be based on the average of the December
2015 and March 2016 quarterly RUG IV scores
RUG III 44 vs. RUG IV 57
■
RUG III -44 OLD Medicaid
RUG IV 57 New Medicaid
Index maximizing
■ Hierarchical version
■ Some care delivered prior to
admission impacted RUG
■ Only care delivered while a resident
impact RUG group
■ Group
– Dr’s orders and visits
– Depression only recognized
in Clinically Complex
■ Only 2 or more Insulin order changes
impact the grouper
■ Behavior and Impaired Cognition
had separate categories
■ Behavior and Cognition are
combined in one grouper
■ ADL range 4-18
■ ADL range 0-16
■ Depression recognized in Special
Care High and Low as well as
Clinically Complex
Hierarchical Classification
(Ohio Medicaid Classification)
■ In the hierarchical approach, start at the top and work down through the RUG-IV 57
model; the assigned classification is the first group for which the resident qualifies. In
other words, start with the Rehabilitation group at the top of the RUG-IV 57 model.
Then go down through the groups in hierarchical order:
–
–
–
–
–
–
–
Rehabilitation (therapy)
Extensive Services (vents, trachs and isolation)
Special Care High (Coma, diabetic with 2+orders, COPD, weight loss, tube feeding)
Special Care Low (CP, Parkinson’s, MS, PU/ wounds)
Clinically Complex (O2, IVs)
Behavioral Symptoms and Cognitive Performance (BIMs <9, behaviors, wandering)
Reduced Physical Function
■ RUGS scoring from 1.0 to 6.4889
Quality System
3
■ Old 20 measure system paying $16.44 goes away
■ New 5 measure system
– Funded through flat $1.79 reduction of each provider’s rate
– Each of 5 quality indicators will be worth approximately 80 cents
per day
■ Indicators vary widely in difficulty of achievement
■ Using 2014 data, ODM estimated only 5 centers would meet all 5
indicators
Measurement Period
■ For state fiscal year 2017(July 1, 2016 rates), the period from July 1,
2015 and ending December 31, 2015 (all ready passed)
■ MDS data will be included from the following:
– Third quarter of calendar year 2015
– Fourth quarter of calendar year 2015 if available by June 1, 2016
■ For state fiscal year 2018 (July 1, 2017 rates) and thereafter, the
calendar year immediately preceding the state fiscal year.
– MDS data will be included from the following:
– The first three quarters of the calendar year
– Fourth quarter data will only be included if available by June 1
How Do I Achieve?
■ Various data sources determine whether the indicators are met:
– MDS data (pressure ulcers, antipsychotics)
– Hospital claims data (potentially preventable admissions)
– Cost report data (retention, PELI)
■ • All data will not be compiled and analyzed until June 2016
Quality Indicator – Pressure Ulcers
■ To earn 1 point, a facility must be at or below the target percentages
for pressure ulcers for both short- and long-stay residents
■ For state fiscal years 2017 and 2018, the rate will be at the 25th
percentile
■ For state fiscal year 2019 and thereafter, the target will be the
number at the 25th percentile in state fiscal year 2018. (Change)
■ No point will be awarded if the facility has no data for either measure
■ Estimated scores = Short term measure 0.00 and long term measure
2.9)
Quality Indicator – Antipsychotic
Medications
■ To earn 1 point, a facility must be at or below the target percentages for
antipsychotic medication use for both short- and long-stay residents.
■ For state fiscal years 2017 and 2018, the rate will be at the 25thpercentile
■ For state fiscal year 2019 and thereafter, the target will be the number at
the 25th percentile in state fiscal year 2018. (change)
■ No point will be awarded if the facility has no data for either measure
■ Estimated scores = Short term measure 0.00 and long term measure 8.7)
Quality Indicator – Preferences for Everyday
Living Inventory (PELI)
On the ODM Nursing Facility Cost Report the following question is
included:
■ Does the nursing center utilize the full or mid-level nursing home
version of the Preferences for Everyday Living Inventory for all of its
residents?
■ 1 point will be awarded if the facility replies yes
■ No point will be awarded if the facility fails to answer the question
Quality Indicator – Potentially Preventable
Hospital Admissions
■ 1 point will be earned if a facility’s actual hospital admission rate is at
or below the risk-adjusted expected rate calculated for their facility
■ Facilities with a score of 1.0 or less
■ Data will be obtained from all hospital claims submitted to ODM –
including crossover claims
■ ODM estimate only 69 facilities will achieve????
Quality Indicator – Employee Retention
■ To earn 1 point, a facility must be at or below the target rate of
the75th percentile.
■ For state fiscal years 2017 and 2018, the rate will be at the
75thpercentile
■ For state fiscal year 2019 and thereafter, the target will be the
number at the 75th percentile in state fiscal year 2018
■ No point will be earned if the facility fails to complete this section
ofthe ODM Nursing Facility Cost Report
Calculation of the Medicaid Per Day Quality
Payment Rate
■ Step 1: Determine the number of Medicaid days delivered by each
facility
■ Step 2: Identify the total Medicaid patient days per facility
■ Step 3: Determine the number of quality points earned by each facility
■ Step 4: Determine the point days earned per facility by multiplying the
Medicaid days by the number of quality points earned
■ Step 5: Determine the number of point days for all facilities
■ Step 6: Calculate the total quality funds to be paid by ODM for the
fiscal year by multiplying $1.79 by the total number of Medicaid days
(roughly $30,000,000)
PA1 and PA2 Patients
■ Flat rate reduced from $130 to $115 effective July 1, 2016
■ PA1/PA2 records still excluded from case mix
■ RUG IV estimated to increase PA1/PA2 patients by about 50%
(1,600 ->2,400)
■ RUG III used for PA1/PA2 billing through June 30, 2016
■ What does it mean to cooperate with the ombudsman?