1. AgeNet-OASN Managed Care Metrics May 14, 2014 Presented By Colleen Lavelle and Cindy Saunders, Jennings Center for Older Adults and Barb Barnette, Saint Augustine Manor

3. AgeNet-OASN Managed Care Metrics Quality committees of AgeNet and OASN reevaluated and made changes to the LeadingAge managed care metrics to: - Improve data consistency - Streamline data collection -Retrieve data from reliable/validated tools

4. AgeNet-OASN Managed Care Metrics New metrics to be reported on the cPMT website beginning July 15, 2014. If new to cPMT, AgeNet or OASN chairs will assist you in how to use the website cPMT reports will enable benchmarking among AgeNet and OASN members Identify and share best practices

5. AgeNet-OASN Managed Care Metrics Metrics critical to demonstrate to payers and other potential partners proven quality Essential to pay for performance and other value based reimbursement arrangements going forward Selected measures are a place to start Will need to be fluid as health care delivery reform evolves

6. Monthly Metrics Reporting MetricReport DateGuidance 1.Nursing Staff Hours per resident day (Short Term Skilled and Long Term Care) 1.a Nursing Staff Hours per resident day (Short Term Skilled Only) 2. RN Staff Hours per resident day (Short Term Skilled and Long Term Care) 2.a RN Staff Hours per resident day (Short Term Skilled The 15 th of the second month following the review period. Example: May 1 -31 review month reported July 15 th. Includes direct and indirect nursing staff Actual hours worked If no distinct SNF unit, 1.a and 2.a would be -0-

7. Monthly Metrics Reporting MetricReport DateGuidance 3. 30 Day Unplanned Readmission Rate (Short Term Skilled Only) 3.a 30 Day Unplanned Readmission Rate (Long Term Care Only) The 15 th of the second month following the review period. Example: May 1 -31 review month reported July 15 th. Hospitalization tracking tool will automatically calculate Follows patients/residents admitted in the review month for 30 days (delayed reporting)

8. Monthly Metrics Reporting MetricReport DateGuidance 4. Unplanned Observation Stay Rate (Short Term Skilled Only) 4.a Unplanned Observation Stay Rate (Long Term Care Only) The 15 th of the second month following the review period. Example: May 1 -31 review month reported July 15 th. Hospitalization tracking tool will automatically calculate Adjusted for census and number of days in month in order to benchmark Expressed in terms of 1,000 resident days (e.g., 3 observation stays per 1,000 resident days or 3 observation stays every 10 days)

9. Monthly Metrics Reporting MetricReport DateGuidance 5. Emergency Room Visit Rate (Short Term Skilled Only) 5.a Emergency Room Visit (Long Term Care Only) The 15 th of the second month following the review period. Example: May 1 -31 review month reported July 15 th. Hospitalization tracking tool will automatically calculate Adjusted for census and number of days in month in order to benchmark Expressed in terms of 1,000 resident days (e.g., 3 emergency department visits per 1,000 resident days or 3 emergency department visits every 10 days)

10. Monthly Metrics Reporting MetricReport DateGuidance 10. Return to Community (Short Term Skilled Only) The 15 th of the second month following the review period. Example: May 1 -31 review month reported July 15 th. Numerator includes return to AL and IL Denominator includes all who became unskilled for any reason including death

11. Quarterly Metrics Reporting MetricReport DateGuidance 6. Falls With Major Injury (Long Term Care Only) 7. High-Risk Pressure Ulcers (Long Term Care Only) 8. UTI’s (Long Term Care Only) 9. New/Worsening Pressure Ulcers (Short Term Skilled Only) Last day of the month that follows the review period. Example: Jan-March review period data is entered on April 30th Obtain data from quarterly CASPER report

12. Quarterly Metrics Reporting MetricReport DateGuidance 11. Patients/Residents who were assessed and appropriately given the flu vaccine (Short Term Skilled and Long Term Care) 12. Patients/Residents who were assessed and appropriately given the pneumococcal vaccine (Short Term Skilled and Long Term Care) Last day of the month that follows the review period. Example: Jan-March review period data is entered on April 30 th (Use the most recent data available on April 30 th even if for an earlier quarter) Obtain data from Nursing Home Compare Website Five Star Report

13. Hospitalization Tracking Tool Utilize the INTERACT or Advancing Excellence Hospitalization Tracking Tool (virtually the same tool) to report 30-day readmission, emergency department visit and observation stay visit rates The INTERACT/Advancing Excellence Hospitalization Tracking Tool is designed to: - Provide clear hospitalization rate definitions consistent with evolving definitions used by CMS and other national organizations - Utilization of this tool will ensure accurate and consistent reporting in the cPMT website

14. Hospitalization Tracking Tool INTERACT/Advancing Excellence tool reports hospitalization rates but is also used for quality improvement Today, we will be focusing on those portions of the tool that need to be completed for reporting hospitalization rates