News, Skilled Nursing Facility

CMS proposes patient-reported outcome measure for SNFs in 2018

Last week, the Centers for Medicare & Medicaid Services (CMS) released their List of Measures under Consideration (MUC) for 2018 pre-rule making. CMS officials capped the measures at 32, more than 100 shy of the 184 measures submitted for consideration by stakeholders during an open call for measures.

Each year, CMS publishes a list of quality and cost measures that are under consideration for Medicare quality reporting and value-based purchasing programs, and collaborates with the National Quality Forum (NQF) to get critical input from multiple stakeholders, including patients, families, caregivers, clinicians, commercial payers and purchasers, on the measures that are best suited for these programs. Ultimately, these measures may help patients choose the nursing home, hospital, or clinician that is best for them, and can help providers to provide the highest quality of care across care settings.

In 2018, SNFs will be studied on a single measure that calculates the percentage of short-stay residents discharged from a SNF after six months, within 100 days of admission. “CMS may have chosen short-stay residents because they usually receive skilled rehab and/or nursing services. This is not always the case for long-stay residents, who commonly receive maintenance care. Short-stay residents also experience the actual discharge process, which is being monitored very closely by CMS,” says Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro.

The “CoreQ: Short Stay Discharge Measure” stewarded by the American Health Care Association will include a four-item patient questionnaire intended to gauge the individual’s satisfaction with their stay. Questions include the following:

  1. In recommending this facility to your friends and family, how would you rate it overall? (Poor, Average, Good, Very Good, Excellent)
  2. Overall, how would you rate the staff? (Poor, Average, Good, Very Good, Excellent)
  3. How would you rate the care you received? (Poor, Average, Good, Very Good, Excellent)
  4. How would you rate how well your discharge needs were met? (Poor, Average, Good, Very Good, Excellent)

Exclusions from the Short-Stay Discharge measure include (1) patients who died during their SNF stay; (2) those discharged to a hospital, another SNF, psychiatric facility, inpatient rehab, or long-term care hospital; (3) Patients with court appointed legal guardian for all decisions; (4) Patients discharged on hospice; (5) Patients who left the nursing facility against medical advice (AMA); (6) Patients who have dementia impairing their ability to answer the questionnaire defined as having a BIMS score on the MDS 3.0 as 7 or lower. Questionnaires completed by someone other than the discharged patient will also be excluded.

CMS explained in a blog post that patient-reported outcome measures “will help empower patients to make decisions about their own healthcare and help clinicians to make continuous improvements in the care provided.”

“Short-stay residents tend to be admitted for more acute conditions (or chronic conditions that have become acute due to exacerbation), which should be resolved rather quickly and show progress/lack thereof over a short period of time,” says Corbett. Approximately 40% of the measures on this year’s MUC list are outcome measures and join eight episode-based cost measures. Comments on the MUC list are open to the public until December 7, 6:00 pm.