RUG and QM Reports Update
Presented to State Veterans’ Homes Administrators
Presented by Janet Barber
National Program Manager, Data Mgmt. and Analytics
Geriatrics and Extended Care Operations
Department of Veterans Affairs
RAI/MDS
 Resident Assessment Instrument/
Minimum Data Set
 RAI/MDS was designed to facilitate
achievement and maintenance of the
resident’s highest practical level of wellbeing by identifying and documenting
individual resident’s needs and strengths,
and incorporating this information into the
resident’s care plan
RUG REPORTS
What is a RUG?
 Resource Utilization Group
 This classification system uses information
from the MDS assessment to classify
nursing home residents into a series of
groups representing the residents’ relative
direct care resource requirements
RUG Basics1
 SVH reports will utilize RUG IV
 There are 66 RUGs in the RUG IV
classification system
RUG Basics2
 Eight major classification categories








Rehab plus Extensive Services
Rehabilitation
Extensive Services
Special Care High
Special Care Low
Clinically Complex
Behavioral Symptoms & Cognitive Performance
Reduced Physical Function
RUG report
Facility: Any SVH
Date Range:01-OCT-13 to 31-OCT-13
Creation Date:07-JAN-14
Average CMI Weight: 9.93 (Total CMI Weight / Total Assessments)
Total Assessments: 171
Total CMI Weight: 1698.0
Number of assessments in this reporting month that were completed late.
This is a count of late assessments for the reporting month,
and may not have been used for the RUGS counts.
Quarterlies : 0
Fulls : 0
Total : 0
RUG Model/Logic Version: 66/103
RUG Weight Set: MEDICARE RUGS Model 66 RURAL-FY2012
Reference: MDS 3.0 Users Manual
DOMAIN
Assmt
#Assmts with
SubDomain RUG (ADL Range) ADL
this RUG & ADL
------------------------------------------------------------------------1. REHAB PLUS EXTENSIVE SERVICES
ULTRA HIGH INTENSITY
RUX (11-16)
RUL (2-10)
VERY HIGH INTENSITY
RVX (11-16)
RVL (2-10)
HIGH INTENSITY
RHX (11-16)
RHL (2-10)
MEDIUM INTENSITY
RMX (11-16)
RML (2-10)
LOW INTENSITY
RLX (2-16)
----------------------------------------------------------Category SubTotal
0
0.0
CMI Weight
this RUG
CMI Wt.
Sub-Total
66.0
65.0
0.0
0.0
64.0
62.0
0.0
0.0
63.0
57.0
0.0
0.0
58.0
55.0
0.0
0.0
52.0
0.0
CMI
 Each RUG group has a weighted value
called Case Mix Index
 Represents the relative use of resources
for a resident
 Case refers to nursing facility resident
 Mix refers to the mixture of different types
of residents cared for in the CLC
Things to consider1
 How do your residents fall into the various
RUG categories?
 Would first pay attention to the residents in the
Reduced Physical Function and the Behavioral
Symptoms & Cognitive Performance categories
 These residents may be served better in a different
level of care


They may be ready for assistive living or admission into your
domiciliary
They may be ready for discharge home with home health
services
Things to consider2
 You can determine the residents’ discharge
goal by the coding in Section Q
QM REPORTS
What is a QM?
 Quality Measure
 One method for determining the quality of
care in a nursing home is through the use
of Quality Measures
What is a QM2
 Quality Measures are derived from
resident assessment data (RAI/MDS)
routinely collected on the residents at
specified intervals during their stay
 Measures are valid and reliable - based on
the best research currently available
What is a QM3?
 Measures are not intended to be
benchmarks, thresholds, guidelines, or
standards of care

Rather,
 They are markers for facility trending and
comparison
 Allows facilities to monitor progress over time
 They are pointers to potential problem areas/areas
of possible weakness
 The SVHs will be receiving from the VA
the Annual survey process report (also
called Surveyors Report). It contains all of
the quality measures plus the addition of 4
immunization measures.
Short Stay vs. Long Stay
 Short Stay Quality Measures:

Include all residents in an episode whose
cumulative days in the facility is less than or
equal to 100 days at the end of the target
period
 Long Stay Quality Measures:

Include all residents in an episode whose
cumulative days in the facility is greater than
or equal to 101 days at the end of the target
period
Short Stay Measures
 Percent of Residents who Self-Report Moderate
to Severe Pain
 Percent of Residents with Pressure Ulcers that
are New or Worsened
 Percent of Short-Stay Residents Who Newly
Received an Antipsychotic Medication
 Percent of Residents who were Assessed and
Appropriately Given the Seasonal Influenza
Vaccine
 Percent of Residents Assessed and
Appropriately Given the Pneumococcal Vaccine
Long Stay Measures1
 Prevalence of Falls
 Percent of Residents Experiencing One or
More Falls with Major Injury
 Percent of Residents who Self-Report
Moderate to Severe Pain
 Percent of High-Risk Residents with Pressure
Ulcers
 Percent of Long-stay Residents with a Urinary
Tract Infection
Long Stay Measures2
 Percent of Low-Risk Residents Who Lose
Control of their Bowels or Bladder
 Residents Who Have/Had a Catheter Inserted
and Left in Their Bladder
 Percent of Residents Who Were Physically
Restrained
 Percent of Residents Whose Need for Help
with Activities of Daily Living Has Increased
Long Stay Measures3
 Percent of Long-stay Residents Who Lose Too
Much Weight
 Percent of Residents Who have Depressive
Symptoms
 Prevalence of Antianxiety/Hypnotic Use
 Percent of Long-Stay Residents Who Received
An Antipsychotic Medication
Long Stay Measures4
 Prevalence of Behavior Symptoms Affecting
Others
 Percent of Residents Assessed and
Appropriately Given the Seasonal Influenza
Vaccine
 Percent of Residents Assessed and
Appropriately Given the Pneumococcal
Vaccine
QM Report
Description
----------Self-Report Moderate to Severe Pain[S]
With Pressure Ulcers New or Worsened[S]
Assessd + Appr Givn Seasonal Influenza Vaccine[S]
Assessd + Appr Given the Pneumococcal Vaccine[S]
Shrt Stay Who Newly Received an Antipsych Med[S]
Expr One or More Falls with Major Injury[L]
Self-Report Moderate to Severe Pain[L]
High-Risk With Pressure Ulcers[L]
Assessd + Appr Givn Seasonl Influenza Vaccine[L]
Assessd + Appr Given Pneumococcal Vaccine[L]
With a Urinary Tract Infection[L]
Low Risk Who Lose Control of Bowel or Bladder[L]
Have/Had a Catheter Insertd + Left in Bladder[L]
Were Physically Restrained[L]
Need for Help w/ Activities Daily Living Incr[L]
Lose Too Much Weight[L]
Have Depressive Symptoms[L]
Received An Antipsychotic Medication[L]
Had a Fall During their Episode of Care[L]
AntianxietyOrHypntcMed+noEvidPsychotcOrRltdTrgtPrd[L]
Behavr Symptoms Affect Others for Trgt Prd[L]
MsmtID
-----N001.01
N002.01
N003.01
N007.01
N011.01
N013.01
N014.01
N015.01
N016.01
N020.01
N024.01
N025.01
N026.01
N027.01
N028.01
N029.01
N030.01
N031.02
N032.01
N033.01
N034.01
Num
---3
38
15
40
2
8
6
3
203
208
8
1
1
0
18
16
1
70
131
0
28
Denom
-----20
38
15
40
7
207
148
109
203
208
208
2
171
208
138
208
187
208
207
75
188
FAC Obs
------15.0%
100.0%
100.0%
100.0%
28.6%
03.9%
04.1%
02.8%
100.0%
100.0%
03.8%
50.0%
00.6%
00.0%
13.0%
07.7%
00.5%
33.7%
63.3%
00.0%
14.9%
FAC Adj
------100.0%
55.1%
52.8%
-
StatAvg
------17.8%
96.6%
88.5%
94.4%
17.8%
03.7%
10.8%
02.2%
99.2%
98.9%
03.7%
50.5%
04.0%
00.0%
12.8%
07.5%
05.3%
29.5%
60.2%
00.0%
23.9%
VISNAvg
------18.0%
94.1%
92.6%
92.5%
11.6%
03.7%
10.2%
04.8%
99.3%
98.5%
05.3%
55.4%
04.2%
00.5%
14.2%
08.2%
05.6%
30.8%
58.4%
00.0%
26.9%
NatlAvg
------22.4%
90.7%
83.6%
83.7%
05.5%
03.5%
10.3%
06.1%
94.1%
96.1%
05.3%
59.5%
05.3%
01.6%
14.7%
07.6%
04.9%
25.8%
53.6%
00.0%
28.0%
NatPctl
------100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
00.0%
100.0%
100.0%
100.0%
100.0%
100.0%
00.0%
100.0%