The Centers of Medicare and Medicaid Services (CMS) has made major changes to the Quality Measures and Five-Star Rating calculations this year.  Now it is up to us to learn how to manage these new measures as well as the old ones. July 1, 2016 brought us six new areas in the CMS Quality Measures.  Five of these areas will impact your Five Star Rating and one that will not affect your Five Star Rating (I am sure that will change in the future too).  

As if those were not enough changes… the final rule from CMS was released on July 31, 2016. The final rule announced three new resource-use quality measures that will go into effect in fiscal year 2018. Long Term Care Post-Acute Care (LTPAC) facilities need to have an understanding of all of these measures and how they are calculated in order to minimize the negative impact on the Quality Measures and Five-Star Rating.

The Centers of Medicare and Medicaid Services Quality Measures

Let’s break the Quality Measures down into Long-Stay (101 and greater days) and Short-Stay (1-100 days):

Current Long-Stay Quality Measures:

1. Percent of Residents Who Self-Report Moderate to Severe Pain
2. Percent of Residents With Pressure Ulcers That Are New or Worsened
3. Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine
4. Percent of Residents Who Received the Seasonal Influenza Vaccine During the Past Season
5. Percent of Residents Who Were Offered and Declined the Seasonal Influenza Vaccine
6. Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Seasonal Influenza Vaccine
7. Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine
8. Percent of Residents Who Received the Pneumococcal Vaccine
9. Percent of Residents Who Were Offered and Declined the Pneumococcal Vaccine
10. Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Pneumococcal Vaccine
11. Percent of Residents Who Newly Received an Antipsychotic Medication
12. Percent of Residents Who Improved Performance on Transfer, Locomotion, and Walking in the Corridor
13. Percentage of Short-Stay Residents Who Were Re-hospitalized After a Nursing Home admission
14. * Percentage of Residents Who Made Improvements in Function
15. * Percentage of Residents Who Were Successfully Discharged to the Community
16. * Percentage of Residents Who Had an Outpatient Emergency Department Visit

Current Short-Stay Quality Measures:

17. Percent of Residents Experiencing One or More Falls with Major Injury
18. Percent of Residents Who Self-Report Moderate to Severe Pain
19. Percent of High-Risk Residents With Pressure Ulcers
20. Percentage of Residents Whose Need for Help With Late-Loss ADLs Has Increased
21. Percent of Residents Assessed and Appropriately Given the Seasonal Influenza
22. Percent of Residents Who Received the Seasonal Influenza Vaccine
23. Percent of Residents Who Were Offered and Declined the Seasonal Influenza Vaccine
24. Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Seasonal Influenza Vaccine
25. Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine
26. Percent of Residents Who Received the Pneumococcal Vaccine
27. Percent of Residents Who Were Offered and Declined the Pneumococcal Vaccine
28. Percent of Residents Who Did Not Receive, Due to Medical Contraindication, the Pneumococcal Vaccine
29. Percent of Residents With a Urinary Tract Infection
30. Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder
31. Percent of Residents Who Were Physically Restrained
32. Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased
33. Percent of Residents Who Lost Too Much Weight
34. Percent of Residents Who Received an Antipsychotic Medication
35. * Percent of Residents Who Used Antianxiety or Hypnotic Medication
36. * Percentage of Residents Whose Ability to Move Independently Worsened.

(*)  Indicates new Quality Measure as of July 1, 2016

New Quality Measures that will go into effect in fiscal year 2018.

1. Medicare spending per beneficiary
2. Residents Successfully Discharge to Community
3. Potentially preventable 30-day post-discharge readmissions.

The CMS Quality Measures Technical Users Guide is a great reference tool; however, at ninety-plus pages it can be an exigent read even if you have a degree in astrophysics.  I have put together a thirteen page Quality Measures Quick Reference Guide (QRG) that will help simplify the CMS tool. Our QRG has all of the current Quality Measures as well as the details on how to calculate the numerator, denominator, exclusions, and covariates.  

Remember you have to manage your Quality Measures and not let them manage you!