QIO NHQI Weekly Update :: October 26th, 2007  

 

TIP OF THE WEEK

Understand the link between quality and reimbursement

 

Ohio is one of a few states that has developed a quality incentive reimbursement program. At the same time, demonstration projects and other discussions have created a buzz among healthcare providers about a pay-for-performance (P4P) model of payment with Medicare. Though current quality incentive payments are fairly modest, the potential for future increases is real and imminent. Below, we discuss the current programs running at the state and federal levels.

 

OHIO QUALITY POINT REIMBURSEMENT FORMULA

The Ohio Department of Jobs and Family Services (ODJFS) awards quality points to Ohio facilities in the following areas:

  • Deficiency-free survey
  • Survey with deficiencies less than level E
  • Resident or family satisfaction survey scores of 85 percent or better
  • Numbers above the statewide average in nursing hours, employee retention, occupancy rate, Medicaid utilization, and case-mix score

According to a 2006 ODJFS report titled “Pay for Performance Purchasing Institute Initiative,” the agency’s long-term goal is to integrate P4P plans for Ohio Medicaid with existing efforts of other payers using electronic health records instead of claims to determine services and outcomes. This goal will likely have an impact on future decisions in Ohio long-term care at the state policy level.

 

FEDERAL MEDICARE DEMONSTRATION PROJECTS

At the federal level, the Centers for Medicare & Medicaid Services (CMS) is involved in demonstration and pilot programs aimed at finalizing its P4P reimbursement protocols in various healthcare settings, including nursing homes. Many private insurers already use this payment methodology. More on the Abt Associates study >>

 

PREPARING FOR FUTURE REIMBURSEMENT

Now is a good time, while nursing home P4P initiatives are still in their infancy stages, to prepare for your future reimbursement by working on your performance in quality measures. Below are a few tips on how to get started:

  • Begin with the big picture. Garner cooperation and a united workforce by starting with education for owners, stakeholders, managers, and support staff.
  • Review policies and procedures and make changes as needed so they align with the goals of current P4P demonstration projects.
  • Review MDS coding procedures. Since performance must be measurable, it will likely depend on the information in the Minimum Data Set (MDS). Look at the process and accuracy of MDS coding, not only for P4P, but also to ensure that your publicly reported quality measures reflect the great care your residents receive.
  • Create community partnerships that will ensure safe and efficient transitions for your residents who travel between various levels of healthcare.

Resources:

 

 

RESOURCE SPOTLIGHT

CEO Survival GuideTM to Pay for Performance
Pay-for-Performance (P4P) is an emergent issue on healthcare executives' radar screens, and it is here to stay for the foreseeable future. P4P has arisen in response to concerns that traditional payment schemes reward the volume of services provided, while placing too little emphasis on the quality and efficiency of healthcare. By paying differentially based on quality and efficiency, public and private purchasers seek to encourage and reward performance improvement efforts.

This survival guide includes key information that every healthcare CEO needs to know.

 

 

 

IN THE NEWS

 

ELDERLY MEDICARE, MEDICAID PATIENTS NOT RECEIVING QUALITY CARE

October 17, 2007 -- Newswire -- If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new UCLA study has found.

 

Using quality-of-care measurements developed by the Assessing Care of Vulnerable Elders (ACOVE) project, researchers found that vulnerable elderly patients received only 65 percent of the tests and other diagnostic evaluations and treatments recommended for a variety of illnesses and conditions, including diabetes and heart disease. Read more >>

 

ADULT DAY-CARE BOOMING

October 14, 2007 -- Cincinnati Enquirer -- One often-overlooked solution to caring for an elderly individual at home is adult day care. But more American families and government leaders are starting to catch on that the options aren't limited to home health care, assisted living facilities, or costly skilled nursing homes. More are discovering -- with great relief -- that adult day centers do vastly more than "baby-sitting" or bingo. Read more >>

 

ZINC MAY REDUCE PNEUMONIA RISK IN NURSING HOME ELDERLY

October 22, 2007 -- Newswire -- When elderly nursing home residents contract pneumonia, it is a blow to their already fragile health. Simin Nikbin Meydani, DVM, PhD of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and colleagues report that maintaining normal serum zinc concentration in the blood may help reduce the risk of pneumonia development in that population.

 

“Based on our data, it appears that daily zinc intake can help nursing home residents who are susceptible to pneumonia, especially those with low serum zinc concentrations in their blood,” says Meydani, who is also a professor at the Friedman School of Nutrition Science and Policy and the Sackler School of Graduate Biomedical Sciences, both at Tufts University. “The study participants with normal serum zinc concentrations in their blood reduced their risk of developing pneumonia by about 50 percent. Additionally, deaths from all causes were 39 percent lower in this group.” Read more >>

 

BED SORES CAN BE STOPPED WITH PROPER CARE IN NURSING HOMES, MEDICARE PROJECT SHOWS

October 22, 2007 -- CMS -- A diligent and sustained focus on preventing serious bed sores in nursing home residents was remarkably effective according to the results of a project sponsored by the Centers for Medicare & Medicaid Services. Results of the project have just been published in the Journal of the American Geriatrics Society. Read more >>

 

 

 

OHIO KEPRO EVENTS

 

Guidelines and Coding for Restraints Teleconference

Featuring Carla Brumby and Patsy Strouse, Ohio Department of Health

November 8, 2007 1:00 p.m. to 3:00 p.m.

Dial-in: 1-866-256-9239

Download the Flyer (PDF)

 

 

INDUSTRY EVENTS

 

Reducing the Use of Alarms in the Nursing Home

Ohio Person-Centered Care Coalition Teleconference

November 6, 2007 1:00 p.m. to 3:00 p.m.

Questions? Call Amanda Trzcinski at 1-614-568-0512 or Leasa Novak at 1-800-385-5080, x2208

 

The Many Facets of Pain Management: An Integrated Approach

November 7, 2007, 8:00 a.m. to 4:30 p.m., MetroHealth Medical Center, Cleveland. Call (216) 778-7707 for more information.

 

Cuyahoga Community College Fall 2007 Calendar:
Continuing Education for Gerontology Professionals

 

Medicare Learning Network:
Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>