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In 2017, The Centers for Medicare & Medicaid Services (CMS) launched a new comprehensive “Meaningful Measures” initiative that identifies high priority areas for quality measurement and improvements needed to advance outcomes for patients, their families, and providers while also reducing burden on clinicians and providers. CMS’s primary goal was to remove obstacles that get in the way of clinicians spending quality time with their patients.

Meaningful Measures will move CMS payment toward value by focusing on everyone’s efforts on the same quality areas and lend specificity, with the following principles for identifying measures that do the following:

  • Promote alignment across quality initiatives and programs which will minimize provider burden.
  • Promote more focused quality measure development towards outcomes that are meaningful to patients, families, and their providers.
  • Identify the big picture quality issues that are the highest priority in improving the health and healthcare of patients and communities.
  • Communicate how CMS programs and measures improve patients’ health and the plan behind delivering value—better care, smarter spending, healthier communities— to meet the needs of patients.

The Breakdown – 6 Quality Categories/19 Meaningful Measures:

  1. Effective communications and coordination of care
    • Medication management
    • Admissions and readmissions to hospitals
    • Seamless transfer of health information
  2. Effective Prevention and Treatment of Chronic Disease
    • Preventive Care Management of Chronic Conditions
    • Prevention, treatment and Management of Mental Health
    • Prevention and Treatment of Opioid and Substance Use Disorders Risk-Adjusted Mortality
  3. Work with Communities to Promote Best Practices of Healthy Living
    • Equity of Care Community Engagement
  4. Make Care Affordable
    • Appropriate Use of Healthcare Patient-focused Episode of Care Risk-adjusted Total Cost of Care
  5. Strengthen Person & Family Engagement as Partners in their Care
    • Care is Personalized and Aligned with Patient’s Goals
    • End of Life Care according to Preferences
    • Patient’s Experience and Functional Outcomes
  6. Make Care Safe by Reducing the Harm Caused in the Delivery of Care
    • Healthcare-Associated Infections
    • Preventable healthcare harm

Time for a Change

CMS decided to make a change to embrace their ‘Patients Over Paperwork’ initiative. The change is showing CMS’s commitment to patient-centered care and improving beneficiary outcomes, it includes several different tasks aimed at reducing the burden for clinicians and it motivates CMS to evaluate its regulations to see what could be improved. Promotes alignment across the continuum and across payers and promotes innovation in new parts of payers.

The Meaningful Measures initiative is to align with existing quality reporting programs and help programs to identify and select individual measures.

Specific Issues Addressed

A new Patient-Driven Payment Model (PDPM) will be implemented for reimbursement that will replace the Resource Utilization Group (RUG) IV case-mix reimbursement model. The new PDPM goes into effect for fiscal year 2020, which begins on Oct 1st, 2019 and focuses on clinically relevant factors to determine payment using diagnosis codes. The new model will encourage more contact between healthcare professionals and patients. It will also focus on the entire treatment of the patient rather than just the volume of services. This will decrease the amount of paperwork and reduce the overall complexity in comparison to the old model. PDPM will also decrease the number of payment group combinations by 80%. It mainly focuses on payments based on the complexity of the patient needs and condition, instead of the volume of hours needed to provide care.

SNFs will have a new evaluation of the Quality Reporting Program (QRP) due to CMS removing measures that were not consistent with the Meaningful Measures initiative. The updated measure focuses on making care safer, strengthening personal and family engagement, promoting coordination of care, promoting effective prevention and treatment and making care affordable.

The SNF Value-Based Purchasing (VBP) program is set to begin on October 1, 2018 and will add a positive or negative incentive payment for services rendered by facilities based on the result of their readmission measure. This final rule will reward providers that takes steps to limit 30-day readmissions of their patients to hospitals.

How SNFs Can Take Action

SNFs will have to assess the types of patients they treat and may have to adjust treatment plans, including the level of care during stays, and realign their operations accordingly. They will also have to assess their documentation procedures and ensure that patient characteristics and needs are accurately captured. SNFs can educate and engage healthcare professionals and review the new documentation formats for each quality measure. The success in meeting a measure is dependent on the engagement of staff and providers, so that the appropriate coding and documentation meet the quality measure specifications. They can also begin looking at appropriate analytical data, which can help with specific performance needs and allow them to begin preparations for the VBP program by reviewing their financial, operational, and clinical policies and procedures.

In Conclusion

SNFs are an important part of many Value-Based Purchasing programs and they are now being incentivized to provide quality of care to patients. They will be rewarded for looking at the needs of the patient instead of how much time a therapist or caregiver spends with a patient. This new program will allow patients and caregivers to pick facilities that cater to their personal needs for care or rehabilitation.

CMS estimates that the new rule will result in an additional $820 million in Medicare reimbursements to SNFs for the 2019 fiscal year due to the 2.4% increase in payment rates.