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In 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act), and with it came the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This legislation mandated SNF metrics reporting requirements, making the careful documentation of all levels of care are a requirement. That means that facilities must now report standardized resident assessment data that complies with the quality measures in place. 

The IMPACT Act’s primary aim is to improve Medicare beneficiary outcomes through shared-decision making, care coordination, and enhanced discharge planning. Each year, on October 1st, CMS publishes the quality measures that skilled nursing facilities must report. CMS encourages facilities to check their SNF metrics reports and ensure complete and accurate data. This ensures the swift and efficient exchange of data between healthcare providers and other post-acute care providers. 

Failure to submit the needed SNF metrics reports will result in a 2% reduction in the Annual Payment Update (APU) for the applicable performance year). 

What Happens After the Data is Reported?

To ensure the accuracy of SNF metrics data, CMS notifies facilities that their data will be made publicly accessible after a certain amount of days. This allows the facilities to review the data before it is published. CMS will initially post a Review and Correct Report on their reporting system, which allows facilities to identify any incorrect data. 

Long-term care staff caring for residents is dictated by SNF metrics.
SNF metrics require careful documentation of all levels of care.

The quality measurements data is inputted every quarter. However, it is worth noting that late submissions are not recognized. Therefore, if facilities need to correct inaccurate data, they must do so before the final submissions deadline.

Following the QRP data submission deadline, the CMS will publish a quarterly Preview Report displaying the same quality measurement data shown to the public. This is a thirty-day preview report that is published before the full quality measures report is made public. 

Because the preview report is published after the submissions deadline, facilities cannot correct or change the data, even if they identify inaccurate data. In such circumstances, SNFs will need to request a CMS review for the incorrect data within thirty days. 

Finally, after the SNF metrics reports are published, they become viewable on the Care Compare website. Care Compare provides a snapshot of each facility’s quality of care, enabling seniors and their families to compare quality metrics for over 15,000 facilities across the nation. 

The quality measures assessed by CMS provide a fair assessment of a facility’s quality of care. However, it poses challenges for skilled nursing facilities, as they must adhere to many regulations. This is why skilled nursing facilities tend to rely on their long term care EHR software systems to aid their documentation processes. The use of long term care software results in reduced medical errors, improved workflow efficiency, and more accurate administrative paperwork.

Efficient nursing home EHR software systems that have a built-in point of care module can help to track resident data more easily with well-designed dashboards that show all resident charts information such as medication, ADLs, and food preferences. They can also send useful pop-up warnings that can be deactivated when necessary, allowing facilities to track their residents’ medical conditions better. 

Some care plan software systems also include a useful Kardex feature that not only displays the day-to-day needs of residents but also comes color-coded, making POC CNA charting easier and more convenient. 

Understanding LTCHs  Quality Measures

For SNFs, CMS notes that there are thirteen quality measures:

  1. Discharge to Community (DTC) and Post Acute Care (PAC)
  2. Medicare Spending Per Beneficiary (MSPB)
  3. Preventable 30-Days Post-Discharge Readmission measure (PPR)
  4. Reporting for the percentage of residents experiencing one or more falls resulting in major injury (Long Stay)
  5. Skilled nursing facility Healthcare-Associated Infections (HAI) that require hospitalization
  6. Drug medication review with re-evaluations for identified issues
  7. Changes to skin injuries (e.g., pressure ulcer) in post-acute care facilities
  8. Records for the percentage of long-term care hospital patients (LTCH) admitted and discharged for functional assessment
  9. Records for IRF functional outcome measures for changes in self-care
  10. Records for IRF functional outcome measures for changes in mobility
  11. Records for IRF functional outcome measures for discharge self-care scores
  12. Records for IRF functional outcome measures for discharges for mobility scores
  13. COVID-19 Vaccination Coverage for all Healthcare Personnel (HCP)

Similar to skilled nursing facilities, LTCHs (Long Term Care Hospitals) adhere to quality measurement requirements. Typically, LTCHs admit patients with complex medical needs that require specialized care for an extended period of intensive hospital treatments. 

LTCH services usually include respiratory therapy, head trauma treatment, and pain management. Many LTCH patients are transferred from an intensive care unit after their condition has improved. Patients will typically spend twenty to twenty-five days in the facility until they can return home. 

Like SNFs, LTCHs also measure quality standards to ensure the processes, outcomes, patient perceptions, and organizational structures result in high-quality patient care. There are currently eighteen LTCH quality measures that are collected and submitted through the following three methods:

Nurse working in LTCHs caring for resident
LTCHs adhere to quality measurement requirements.
  • LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) – This is an assessment tool used to collect patient data. LTCH facilities follow the Quality Reporting Manual (QRP) that guides LTCH staff on how quality data is collected, submitted, and reported in compliance with the LTCH QRP requirements. In addition, the manual offers step-by-step coding instructions and examples so LTCH staff can accurately complete the continuity assessment report. 
  • Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) – This is a national network used for infection tracking. The data is accessible nationally, identifying problem areas, prevention efforts, and any healthcare-associated infections, such as personnel influenza vaccine statuses and infection control rates. This allows facilities to see real-time analytics, allowing them to assess and identify causes for concern with infection reporting.
  • Medicare fee-for-service claims – Fee-for-service refers to a type of Medicare payment model where any healthcare services rendered are paid for individually. The original Medicare model and Medicare Advantage plans fall into a fee-for-service model. Alternatives to fee-for-service include the value-based or bundled payments that are based on outcomes and efficiency rather than for each individual service. 

The LTCH quality measures require facilities to submit their data to CMS under two conditions:

  1. The collected quality measures data through LCDS must be submitted using the Internet Quality Improvement and Evaluation System (iQIES). This data must be at least eighty percent complete.
  2. The quality measures data collected and submitted using the CDC NHSN must be one-hundred percent complete.

Should facilities fail to meet the requirements, a two-percent reduction will be enforced in the LTCH’s Annual Update. Again, like SNF metrics, the LCDS data must also be submitted to CMS before the final submission deadline. Facilities will not be able to modify the data with late submissions, which impacts the accuracy of the quality measurement data that is published on the CMS Care Compare webpage.

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Implementing a SNF Quality Reporting Program With CareMetrics

Both skilled nursing facilities and LTCHs are held to the CMS quality measurements in the SNF quality reporting program. The QRP reports help facilities to predict their outcomes by giving them time to assess the results, work on their quality performance measures, and make improvements before the reports are made public. 

Such advantages, though, are only possible when SNF metrics and LTCH QRP assessments are entered into the facility’s long term care software. This allows facility staff to track the information, organize their processes, and address needed improvements to maintain high-quality standards. 

Long term care software systems can help alleviate the burden of organizing SNF metrics and LTCH QRP data, as data is stored in a centralized location. This means that authorized staff can access, create, and update patient data throughout the facility. Simultaneously, improving the efficiency of their workflow and accuracy of inputting real-time data that complies with CMS requirements.   

Of course, maintaining a high quality of care is a priority for all healthcare facilities. However, equally important is ensuring that the high quality of care given to patients falls within the facility’s budget. That is why analytics tools for the financial side, like CareMetrics, are so valuable.  

.While skilled nursing facilities or LTCHs must be able to report quality reporting programs for LTCHs, they must also think of the money coming in and out so that they can better distribute funds. CareMetrics gives leaders a bird’s eye view of their organizations so that they can better assess their budget, AR Days Outstanding, AP Aging, track cash receipts, and identify focus buildings. This analytics tool also allows you to generate census reports and navigate between data related to census and cash flow seamlessly. 

The Importance of SNF Metrics

A nurse showing a resident the SNF quality reporting program
A SNF quality reporting program is used alongside LTC software.

SNF metrics allow facilities to improve their quality of care by putting into perspective the factors that impact their performance. This gives them the chance to set attainable and timely goals for improvement without overwhelming their staff with unrealistic goals and expectations. 

Whether it be SNF or an LTCH, providing excellent care within budget is crucial. Hence the importance of investing in an efficient long term care EHR system that can synchronize both clinical goals and financial budgets. The latter is now easier than ever with the most advanced analytics tool, CareMetrics. This allows facility staff to know which payors to pursue and which buildings are lagging behind in performance. That knowledge will help them forge a sustainable plan for quality measurements while maintaining accurate financials that enable proper reimbursements. 

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Cindy Wong