Adviser Fall 2018 Vol 1 - Page 22

21 Need to Know: New Long-Stay Claims-Based Hospitalization Measure Now on Nursing Home Compare By Susan Chenail, RN, CCM, RAC-CT, senior quality improvement analyst THE Centers for Medicare and Medicaid Services (CMS) believes that residents who return to the hospital frequently during their nursing home stay for unplanned reasons are less likely to be receiving proper assessments or care. In an attempt to widen those included in hospitalization measures, CMS has created a new measure that is comprised of long-stay residents titled Number of Hospitalizations Per 1,000 Long-Stay Resident Days. This brand-new measure is not the measures we are familiar with – for example, Percentage of Short-Stay Residents Who Were Rehospitalized After a Nursing Home Admission or Short-Stay Residents Who Have Had an Outpatient Emergency Department Visit, used to calculate the quality measure domain of the Nursing Home Compare (NHC) Five-Star Quality Rating System. This new hospitalization measure reports the ratio of unplanned hospitalizations per 1,000 long-stay resident days. Keep in mind that this is a claims-based measure which includes those residents on traditional Medicare Fee for Service (FFS), and it is also a long-stay measure which includes those residents in the facility for more than 100 days. The Nursing Home Compare Claims-Based Quality Measure Technical Specifications September 2018 update contains more details on the new measure, including purpose, description, numerator, denominator and exclusions. Short-Stay Residents Who Were Rehospitalized After a Nursing Home Admission. The measure used in the graph titled Short-Stay Emergency Department Visits is Short-Stay Residents Who Have Had an Outpatient Emergency Department Visit. In both measures, a lower rate is better. The data was derived from NHC reporting quarter July 2018 and the data collection period of Oct. 1, 2016 through Sept. 30, 2017. New York Non-Profits’ performance on both measures was compared to that of their New York For-Profit, New York State and National peer groups. In the first graph depicting rehospitalization, the vertical axis is the groups, and the horizontal axis is the rate. Analysis of Short-Stay Rehospitalization shows that New York Non-Profits are outperforming their peers, faring 3 percent better than New York For-Profit Nursing Homes, 5 percent better than New York State and 13 percent better than the nation. Quality Metrics was used to produce the following graphs pertaining to utilization of hospital services. The claims-based measure used in the graph titled Short-Stay Rehospitalization is Percentage of Adviser a publication of LeadingAge New York | Fall 2018 In the second graph depicting emergency department visits, the vertical axis is the groups, and the horizontal axis is the rate. Analysis of Short-Stay Emergency Department Visits shows that