1. LTC Trend Tracker Peggy Connorton, MS, LNFA
Director, Quality and LTC Trend Tracker

2. Benefits of LTC Trend Tracker
AHCA member resource
Benchmarking against your peers
Increases efficiency – saves you time
Data in one central place – pulled using Medicare number

3. AHCA Quality Metrics Rehospitalization Discharge to Community
Length of Stay

4. Risk-Adjusted Rate

5. Data Source MDS 3.0 Over a 12-month period
Based on admission assessment (5 day or OBRA)
Discharge assessment

6. Rehospitalization Measures
National measures based on claims
•Excludes ER visits & observation stays
•Excludes Medicare Advantage & private insurance
•Most measures
•Fail to risk adjust for differences in patients
•Claims allow for limited clinical information to risk adjust

7. Risk-Adjusted Rate
Actual to Expected Ratio >1 you rehospitalized more people than expected

8. Rehospitalization Data
MDS 3.0-based measure
Adjusted rate
Expected rate
Actual rate
Use in telling your story to hospitals
Benchmark your Rehospitalization to your peers

9. Rehospitalization How to interpret your results
How do I compare to others? – look at risk adjusted results
Are you getting better? – look at your actual results
Are you admitting sicker patients? – look at your expected
Are you admitting more or less than expected? – look at your actual to expected ratio
Risk adjusted is getting better but your actual and expected have not changed much.
You are doing better compared to others
Your admissions have about the same acuity over time (e.g. they are not sicker in Jun 2014 compared to Jun 2013)
Your ratio is 1.0 or less meaning you send fewer patients back to the hospital then expected (this is why your risk adjusted value is 3-4% points less than your actual (21% vs 18%)
- however you still have room to do better since your ratio is close to 1.0 most of the time.

10. How to interpret your results
Risk adjusted is getting better but your actual & expected have not
Means you are doing better compared to others but you are not improving much
Your admissions have about the same acuity over time (e.g. they are not sicker in Jun 2014 compared to Jun 2013 – based on expected rate)
Your ratio is 1.0 or less meaning you send fewer patients back to the hospital than expected (this is why your risk adjusted value is 3-4% points less than your actual (21% vs 18%)- however you still have room to do better since your ratio is close to 1.0 most of the time.
Risk adjusted is getting better but your actual and expected have not changed much.
You are doing better compared to others
Your admissions have about the same acuity over time (e.g. they are not sicker in Jun 2014 compared to Jun 2013)
Your ratio is 1.0 or less meaning you send fewer patients back to the hospital then expected (this is why your risk adjusted value is 3-4% points less than your actual (21% vs 18%)
- however you still have room to do better since your ratio is close to 1.0 most of the time.

11. Rehospitalization Report

12. Actual Rehospitalization

13. Risk Adjusted Trend

14. Finding Percentiles
Need to know the center percentile for rehospitalization
Determine Ranking by selecting the more button
Look at current practices to see what changes you need to make to get to the next percentile level

15. Percentile info

16. Discharge to Community
Determine how you compare in your d/c to community rate
Private home, apartment, board/care, assisted living, or group home as indicated on MDS discharge assessment
Uses MDS Data from the d/c assessment

17. Discharge to Community Report

18. Discharge to Community
The measure is risk adjusted using 59 variables in six domains: demographic, functional status, prognosis, clinical conditions, clinical treatments, and clinical diagnoses

19. How to use DC to Community
See how you are doing on your dc rate to home and other nonclinical settings
It can also tell you if you are sending more or fewer than expected individuals back to the community given the clinical characteristics of the population of individuals admitted to your center
Use negotiations with hospitals, Manage Care organizations and others.

20. Five Star Rating Reports
Overall, Staffing and QM Report
QM-- Identify focus QMs for quality improvement
Predict impact of QM improvements on Five-Star QM Rating
Predict Staffing Five Star Rating

21. Five Star QM Report Look at your current QM Five Star Rating
Determine QMs to focus from the Five Star QM Report
Look at your current resident population
Enter your scores and see the affect on your overall QM score
Members use this report to see if they will maintain their five star rating

22. Sample Five Star overall

23. Changes with Staffing Look at Staffing Five Star Report
Determine expected vs reported
Did you enter the correct data during last survey?
What does CMS Expect you to run?
Look At CASPER Staffing Report for reported hours

24. Five Star Staffing Rating

25. Five Star Staffing Report

26. RN hours

27. Five Star Staffing Report

28. Casper Staffing Report

29. Five Star QM Rating

33. SS Stay Antipsychotic

34. LS Antipsychotic

35. FUTURE CHANGES TO FIVE STAR IN 2015 & 2016
CMS plans to add additional quality measures to Five-Star
Rehospitalizations
Discharge back to community
Staffing turnover and retention
Other measures from IMPACT act
Change how much measures contribute to scoring based on CMS audits of MDS and Staffing reports
Linkages to individual state reporting and inspection results

36. CMS raised the bar, now SNFs return to work of quality improvement
Outline of a strategy for improving your Five Star rating:
Decrease survey score (frequency of tags weighted by scope and severity)
Monitor deficiencies (Trend Tracker)
Implement strategies to reduce them
Must be consistent, as survey score is 3-year average
Increase RN and DCS staffing
Monitor staffing (LTC Trend Tracker)
Implement strategies to increase PPDs (see the Trend Tracker Five Star staffing predictor)
Improve the 11 QMs
Monitor QMs (LTC Trend Tracker)
Implement strategies to improve them (see the Trend Tracker Five Star QM predictor)
Also must be consistent, as there is roughly a 6 month delay before appearing in Nursing Home Compare, and most measures are based on 12 months of data. So sustain improvement for at least 18 months.
Also decrease rehospitalizations and increase discharge to community rates, as they will be added to Five Star QM component in 2016

37. The full list of elements to target in your Five Star strategy…

38. What you can do
Embrace Value Based Purchasing Programs – they allow you more control over your payment
Embrace data and the feedback it provides
The details matter – learn the details of each proposed measure and train your staff
Keep an open mind as you perform root cause analysis
Establish a common goal within your center

39. When you get back Look at Rehospitalization rates, implement INTERACT
Review your Five Star Rating
Use your clinical systems and root cause analysis to make changes
MDS Process
Use Free Tools such as Advancing Excellence or LTC Trend Tracker.

40. Contact Info
Peggy Connorton or