Survey Outcome and Activity Reports (SOAR) Updates to the LTCSP SOAR March 2019 (SHOW THIS SLIDE) Welcome to the training on SOAR Updates. This is Pat Walker and Meg Kaehny from the University of Colorado and we will be conducting the training. Our team assisted CMS in developing the LTCSP so we have a thorough understanding of the survey process. We have also been actively involved with the software contractor, Alpine Technology Group, in developing the software that supports the LTCSP. As part of our contract with CMS, we generate and distribute the SOAR. LTCSP

SOAR Overview and Updates Survey Outcome and Activity Reports (SOAR) Help SAs, ROs, and CMS understand LTCSP performance Excel spreadsheet Sent monthly Update on SOAR Changes as of March 2019 (SHOW THIS SLIDE) Many of you have already been using the SOAR. Let’s just do a quick review. SOAR refers to Survey Outcome and Activity Reports. These are a series of Excel spreadsheet tabs that display information about state performance of the Long Term Care Survey Process. The SOAR is distributed monthly and provides information intended to help understand and reinforce or improve LTCSP performance. This training is focused on the latest updates to the SOAR, which were implemented as of March 2019. Another recorded training posted on October 5, 2018 describes the SOAR tabs that have not been replaced with the current updates. That training can be found on the ISTW. LTCSP

New SOAR Tabs Select Performance Measures – state, region, national Replaces Overview tab New measures on SA effectiveness, efficiency, and workforce Select Performance Measures – Survey Level Provides state survey level information on each of the Select Performance Measures Replaces Overview – Survey Level tab (SHOW THIS SLIDE) The SOAR updates include the addition of four new tabs and a new filter feature on the survey and surveyor level tabs. The first new SOAR tab includes a new set of measures, called Select Performance Measures. The Select Performance Measures tab displays information on the state, region, and national levels and replaces the Overview tab. The Select Performance Measures address state agency effectiveness, efficiency, and workforce. Some of the measures are similar to the information included on the old Overview tab and some of the measures are new. The second new SOAR tab provides survey level information for most of the Select Performance Measures that are shown on the first tab. This tab replaces the Overview – Survey level tab. We will review these tabs in more detail during this training. LTCSP

New SOAR Tabs (Continued) Potential Citation and Scope and Severity Level – Surveyor Level 2567 Citations Downgraded or Removed via IDR/IIDR (SHOW THIS SLIDE) The third new SOAR tab shows potential citation information on the surveyor level. This is the only tab at this time that shows surveyor level information. The fourth new tab provides information on whether cited tags that underwent either IDR or IIDR were downgraded in scope and severity or removed as a result of the review.   LTCSP

New Filter/Sort Feature New filter/sort feature on survey level tabs to facilitate information review Use to group and re-order surveys by a particular area Helps highlight patterns or trends (SHOW THIS SLIDE) The final SOAR update at this time is the addition of a new filter and sort feature on several survey level tabs. This feature will help users group and re-order the surveys by a particular area to help make it easier to detect whether any patterns exist in the data. During this presentation, we will demonstrate a few ways to use the filter and sort feature.   LTCSP

Measure 14: High FI, Low Potential Cite Rate Measure 14: Number of Care Areas with a High FI and Low Potential Cite Rate (41 Total) Care Areas Investigated Frequently but Cited Relatively Rarely High FI Rate = Top 25th Percentile of All States’ FI Rates for the Area Low Potential Cite Rate = Bottom 25th Percentile of All States’ Potential Cite Rate for the Area Excludes States with Fewer than 15 Surveys Only Number of Care Areas on First Tab Specific Care Areas Highlighted on Investigations – Surveys Tab (SHOW THIS SLIDE) Measure 14 is the number of care areas that have a high FI rate but also have a low potential citation rate. So, these care areas are investigated frequently but cited relatively rarely. Note that this measure excludes surveyor initiated investigations. So, what do we mean by a high FI rate? This means that the SA investigated the care area at a rate that is in the top 25th percentile of FI rates for that care area among all SAs nationally. We calculate these percentiles for each care area separately. A low citation rate is defined for this measure to mean that the care area was cited by the SA at a rate that is in the lowest 25th percentile of the citation rates for the care area across all SAs nationally. These are calculation details for those who are interested, but the main point is that the care area was investigated at a high rate but cited at a low rate. Note that states with fewer than 15 total surveys during the time period are excluded from the percentile calculations. If your state had fewer than 15 surveys, there will be a dash shown for this measure for your state on the first tab. Note that this measure only shows the number of care areas that have a high FI rate and low citation rate. To see which particular care areas these are, you can click on the Additional Detail link for this measure on the first tab and review the information on the SOAR Investigations – Survey Level tab. The relevant care areas will be highlighted in yellow on this tab. We will show an example of this in a bit. One more point to note is that a few of the care areas included in this measure are atypical because surveyors can’t mark them as FI during the initial pool. There are no interview, observation, or limited record review items that directly trigger the investigations. Investigations for these care areas are triggered in other ways. These areas are Dementia Care, Death, and Unnecessary Meds. These areas are triggered for investigation using other methods. For example, Unnecessary Meds is investigated on every survey and should therefore show a 100% investigation rate. So, if one of these areas are included in your state’s count of high FI and low cite areas, look more at the fact that the area had a low citation rate. LTCSP

Onsite Time: Measures 20a – 20d Average onsite hours now shown for four facility size grouping Groups based on Attachment A to LTCSP Procedure Guide, divided at point when another surveyor is added to team 1 to 48 residents 49 to 95 residents 96 to 174 residents 175 or more residents Advantages of showing time by subgroups Avoids masking high onsite time concentrated in particular facility size groups Helps SAs identify whether high onsite time is associated with particular facility sizes and focus efforts to identify root causes and change practices (SHOW THIS SLIDE) Let’s talk a little more about the next four measures. Select Performance Measures 20a to 20d present the average number of onsite hours reported on the CMS-670. The hours are presented separately for four different facility size groupings. These are listed on the slide. These groups are based on the point at which the recommended number of surveyors increases in Attachment A to the LTCSP Procedure Guide. The data are presented in this way to reduce the masking that can occur when averaging the onsite hours across all facility sizes. Presenting onsite time by facility size group allows SAs to identify whether high onsite time might be concentrated in a particular facility size group or if it occurs across all facility size groups for their state. This information can help SAs focus efforts to identify root causes and address the issues with training or other efforts to reduce onsite hours. LTCSP

Conclusion Updated SOAR provides a wider breadth of information Select Performance Measures tab and links to Additional Details Surveyor Level Tab, IDR/IIDR Tab Refer to updated SOAR Guide sent with the March 2019 SOAR Questions? Please contact CMS NH Survey Development (NHSurveyDevelopment@cms.hhs.gov) (SHOW THIS SLIDE) That concludes our review of the March 2019 updates to the SOAR. The updated reports provide a wider breadth of information for states through the Select Performance Measures tabs. In addition, the updated SOAR provides states with a new method - using the Additional Detail links - to easily access survey level information that can be used to help identify the root causes of notable differences identified on the Select Performance Measures. The SOAR also now includes potential citation information on the surveyor level as well as the addition of survey level IDR/IIDR information. Please refer to the updated SOAR Guide sent with the March 2019 SOAR for detailed information on the new Select Performance Measures and all of the other SOAR tabs. If you have any questions, please email CMS Nursing Home Survey Development at the email address shown on the slide. Thank you. LTCSP