Quality in Post Acute Care: Using Data to Differentiate Cheryl Phillips, M.D., Senior VP Advocacy and Health Services

Fee for Service Volume Population Health Value-based Payment

News Release U.S. Department of Health & Human Services News Division Better, Smarter, Healthier Care 30% of Medicare FFS payments will be tied to “alternative” models, such as ACOs, bundled payment arrangements by % of payments will be tied to these models by 2018

The “Triple Aim” Population Health Experience of Care Per Capita Cost

Care Transitions and Reducing Hospital Admissions ---- The New Currency of Health Care Reform

What CMS Will be Looking For Reduced hospital admissions / readmissions Reduced TOTAL resource use (bundles) Reduced health care acquired infections Reduced antipsychotic use Expanded 5-star measures Staffing and staff turn-over Resident satisfaction

All This Will Feed Into Payment Shared Savings Models Bundled Payments Quality Incentives Penalties Value-based Payment for PA/LTC

Risk-Bearing Entities Will Look to Decrease Variation in Post-Acute Spending 8 LTACH IRF HHA SNF Hospital 73% of the regional variation in Medicare spending is due to variation in post-acute care spending LTACH: Long-Term Acute Care Hospital; IRF: Inpatient Rehabilitation Facility; SNF: Skilled Nursing Facility; HHA: Home Health Agency Sources: 1. Newhouse JP, et al. Variation in health care spending: Target decision making, not geography. Institute of Medicine report brief. July 2013; 2. MedPAC June 2013 Data Book: Health Care Spending and the Medicare Program (p. 3).; 3. Regional variation in Medicare use. MedPAC Report to the Congress. Jan Regional Variation in Medicare Spending

Who Else will be Looking? ACOs “Bundled” payment providers Managed Medicare Medicaid LTSS plans Consumers

NH Five-Star Quality Measures Long-stay residents – % whose need for help with ADLs has increased – % of high risk residents with pressure ulcers – % of residents who have/had a catheter placed and left in their bladder – %of residents who were physically restrained – % of residents with a UTI – % of residents who self-report mod to severe pain – % of residents experiencing one or more falls with major injury – % of residents who received an antipsychotic medication Short-stay residents – % of residents with pressure ulcers that are new or worsened – % of residents who self-report mod to severe pain – % of residents who newly received an antipsychotic med

Longer-Term Potential Further Improvements to NH Compare (per CMS) Dynamic consumer testing Interactiveness: Make the website more interactive to refine search Staffing Data: Collect staffing data based on payroll sources, submitted quarterly Quality Measures: Add new quality measures (hospitalization measure…others?)

Longer-Term Potential Further Improvements to NH Compare NH Characteristics + Capabilities: Add additional information about nursing homes –Private rooms –Languages spoken –Availability of specialty units (rehab, ventilator support…) Satisfaction Surveys: Study potential reporting of satisfaction survey results – residents, families, staff

IMPACT Act Improving Medicare Post-Acute Care Transformation – “IMPACT” Legislation introduced in June,2014 In addition to new reporting requirements – sets the path for new models of post- acute payment Standardized Assessment and standardize reporting domains New look at “return to community”

IMPACT Quality Measures Functional status and changes Cognitive function and changes Skin Integrity Special services, treatments, etc (resource use) Medical conditions and co-morbidities Other impairments Medication reconciliation* Major falls* Patient preferences* * CMS is currently in development of standardized reporting measure

A Step by Step Guide to Building a Quality Assurance and Performance Improvement (QAPI) Program in Your Nursing Home

Providing Solutions for You Hospital Admissions Infection Control Staff Retention Person-centered Care Consistent Staffing Antipsychotic Meds 5-star Measures QAPI

Examples of Solutions to Measure Quality and Drive Change in Nursing Homes

The Readmission Report

Market Position Reports by Avalere, powered by VANTAGE CPS Ask the Avalere Expert LeadingAge Quality Metrics (Just Added Home Health!) LeadingAge Survey and Certification Reports Ask the MDS Expert Ask the Housing Expert

How Does All This Affect Post Acute Care….and ME?

In Short… Quality is now currency Quality transformation requires the WHOLE team: Leaders, clinical staff, admin staff, direct care….EVERYONE Meaningful / actionable quality data is key We truly can transform post acute care!