New Quality Payment System Effective 7/1/2012
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H E A L T H C A R E U P D A T E |
November 2, 2011 |
| New Quality Payment System Effective 7/1/2012 |
For additional information and discussion on this topic, please get in touch with your regular HW&Co. professional or one of our HW Healthcare Advisors listed below. Lindsay Glavan, CPA |
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in this article: · Summary of New Quality Payment System Effective July 1, 2012 · The Finer Points of the New System
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Prepare Now for New Quality Payment System Taking Effect July 1, 2012 On July 1, 2012 (FY13), a new quality payment system will replace the current system. The proposed quality measures have been presented to the State Legislature and are expected to be passed into statute by December 31, 2011. To give you an idea of its impact, for a 100 bed facility with state-wide average occupancy and Medicaid utilization, the quality component of annual Medicaid reimbursement will be approximately $330,000. Missing one point will cost that facility approximately $66,000 in reimbursement. As you can see, maximizing quality points earned will be critical to continued success in FY13 and beyond. Earning the $16.44 maximum per diem quality payment is achievable for all facilities in FY13, but action is required. Currently, the quality payment average is $3.03 per day. However, the new quality incentive system represents, on average, only $1.94 per day ($16.44 - $3.03 - $11.47 = $1.94) of new money in the Medicaid system. The maximum quality payment is increasing primarily because a greater portion of your per diem rate will be earned through quality measures while the franchise fee component of the rate ($11.47) will be eliminated. In other words, facilities will have to earn the “bed tax” component of their rate. The quality component will be earned by meeting any 5 of the 20 quality measures summarized below. Take action now to ensure your facility: · Earns at least 5 points worth $3.29 each, or $16.44 of the FY13 per diem rate · Receives reimbursement from the potential bonus pool, allocated to facilities earning more than 5 points · Is prepared for FY14 and beyond, when the number of points required to earn the maximum quality payment will likely increase, which could decrease the number of facilities earning the maximum incentive, and increase the bonus pool to be allocated to high performing facilities. We encourage you to review these measures now, and start the conversation with your management team about measures you want to earn, and the steps required to make that happen.
Proposed Quality Measures
(1a) Achieve an overall score of at least 86 on Ohio’s Resident Satisfaction Survey (odd-numbered fiscal years). (1b) Achieve an overall score of at least 88 on Ohio’s Family Satisfaction Survey (even-numbered fiscal years).
(2) Enroll and participate in the “Advancing Excellence in America’s Nursing Homes” campaign. (a) Facilities must enroll and select at least three (3) goals.
(3) On the most recent standard survey and any complaint surveys conducted in the calendar year preceding the fiscal year, receive no: (a) Health deficiencies with a scope and severity level greater than F. Note: The complaint survey is not included in the current quality system.
(4) Offer at least 50% of residents at least one of the following dining choices for at least one meal each day. The facility must maintain a written policy regarding meal choices and must communicate the policy to staff and residents. (a) Restaurant style where staff take resident orders;
(5) Offer at least 50% of residents the ability to take a bath or shower as often as they like. Facility must maintain a policy regarding bathing choices and the policy must be communicated to staff and residents.
(6a) On the Ohio Resident Satisfaction Survey achieve a score of at least 89 for the question “Can you go to bed when you like?” and a score of at least 76 for the question “Can you decide when to get up in the morning? (6b) On the Ohio Family Satisfaction Survey achieve a score of at least 88 for the question “Can the resident go to bed when he/she likes?” and a score of at least 75 for the question regarding the resident’s ability to get up when they choose.
(7) Demonstrate that at least 75% of residents have the opportunity to discuss their goals for care including their preferences for advance care planning with an appropriate member of the healthcare team following admission and prior to completing or updating the plan of care quarterly. These preferences must be recorded in the resident’s medical record and used in the development of their plan of care.
(8) On the MDS assessment process, no more than 4% of long stay residents report severe to moderate pain.
(9) On the MDS assessment process, no more than 9% of long stay, high risk residents, are assessed as having one or more stage 2 to 4 pressure ulcers.
(10) On the MDS assessment process, no more than 2% of long stay residents are reported as physically restrained.
(11) On the MDS assessment process, fewer than 10% of long stay residents are reported to have had a urinary tract infection.
(12) Track and document admissions of residents to a hospital. The facility must implement a policy to reduce hospital admissions for residents. The policy must identify those tools used to track hospital admissions.
(13) Have 50% or more of your Medicaid certified beds in private rooms.
(14) Provide accessible resident bathrooms, all of which meet any two of the following three standards and some of which meet a third standard: (a) Resident room mirrors are wheelchair accessible and/or adjustable in order to be visible to a seated or standing resident;
(15) Maintain a written policy that eliminates overhead paging systems or limits use of overhead paging systems to emergencies, as defined in the policy. Communicate this policy to staff and residents.
(16a) On the Ohio Resident Satisfaction Survey achieve a score of at least 90 for the question “Can you fix up your room with personal items so it looks like home?” (16b) On the Ohio Family Satisfaction Survey achieve a score of at least 95 for the question “Can the resident bring in belongings that make his/her room feel homelike?”
(17) Maintain a written policy requiring consistent assignment of STNAs. Communicate the policy to residents, families and staff. Specify a goal limiting the number of STNAs that provide care to a long term resident to no more than 8 STNAs over a 30 day period.
(18) Maintain an employee retention rate of at least 75%.
(19) Maintain and document STNA turnover rate at or below 65%.
(20) Document that STNAs who are primary caregivers for residents attend and participate in at least 50% of the resident care conferences in the facility.
For further discussion or assistance meeting these measures, contact your HW&Co. Healthcare Advisor.
Some Finer Points on the New Quality Payment System
Please feel free to contact us if you have any questions on the new quality measures or how your facility might be affected.
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