Event ID: 2662938
Event Started: 7/10/2015 10:53:06 AM ET
Please stand by for realtime captions.
Good morning my name is Jessica and I will be your conference operator today. Of this template
like to welcome everyone to demystifying the five star quality measure calculation webinar. All
lines have been placed on mute to prevent any background noise. After speaker's remarks it will
be a question-and-answer session. It like to answer -- ask a question for a*they want on your
telephone keypad if you like to withdraw your question press the pound key. I would now like to
turn the call over.
Thank you, Jessica welcome to everyone to demystifying the five star quality measure
calculation webinar. That is a mouthful. I, member of the nursing home team from the quality
innovative network. I am joined on this call, helping me on chat is Cheryl mall -- Cheryl Marcia
and Nell Griffin. We include skilled nursing homes from Colorado, Iowa and Illinois and you
have quality improvement facilitators from these three states as well. As a collaborative partner I
would like to remind you that you can share questions, thoughts, ideas in the chat pod throughout
the presentation. Phones will be muted for the presentation and questions will be taken at the
and. The PowerPoint presentation has been emailed to all of you who have registered for the
event as of Thursday, July 9. If you do not have a copy of the presentation we suggest you
request it through the chat and make sure you share your e-mail. Telegen's nursing home
collaborative presented to a we believe nursing homes can use to better understand the points
assigned to each quality measure rate used in the five star quality rating for only the quality
measure domain. At the end of the presentation you should be able to identify the three domains
used to create the overall five-star rating and you will also explore how to use your current
quality measure data to estimate your potential star rating. Which should health you identify
improvement opportunities. It is a big galaxy out there. In 2008 CMS changed the nursing home
compare to include more information about the quality of care. Their goal was to health
consumers find and compare quality nursing homes. Now in February of this year, CMS has
made three significant improvements to the five-star nursing home quality rating system. One is
they incorporated the two nursing home quality measures for antipsychotic use into the quality
measure rating. And it is included in your calculation out. They increase the number of points
necessary to earn a quality measure start rating of two or more stars and you can learn more
about that in the technical user guide from the season -- CMS website. They also change the
scoring method for the staffing star rating. We have three states on this call and I think it is
interesting for us to share with you that Iowa went from 32, one star nursing homes to 60 after
the change in February. Almost double. Eloquently -- crinoline from 73 to 135 nursing homes
and Colorado currently has 24 star one nursing homes. This world we are in, is changing. Right
now, from the quality perspective in CMS, our focus is on reporting, becoming more transparent.
Sin, there will will be a penalty for not reporting and also for not performing well. The impact
act of 2014 addresses penalties for not reporting. This is new for skilled nursing facilities, but
hospitals already have a quality reporting program. Beginning fiscal year 2018 in each
subsequent great year, the Secretary shall reduce payment rates during such fiscal years by two
percentage points for any skilled nursing facility that does not comply with data submission
requirements for such -- for that fiscal year. It is important for your organization to be prepared
but also acutely aware of the data you submit as it will be interpreted by consumers, hospitals
and potential staff. Additionally, the impact act expects some type of additional measures that
will address in changes, -- skin changes, balls with major injury, cognitive function including
changes that may occur with either one of those functions. So we may be seeing a change in this
quality measure or an addition. Beginning in 2019, of value -based purchasing program will
address all cause unplanned readmission rates within 30 days of hospital discharge. As we said,
there are many, many changes ahead but today we want to make sure members of our
collaborative have a very clear understanding and also a tool to health manage the quality
measure rating on the five-star rating system.
On this slide we have a little bit of a review of nursing home compare and what the stars are
rated as. For the first time since the five-star quality rating system was introduced six years ago,
CMS has reset the skill to identify the number of points needed to achieve different star rating.
We talked about that earlier. CMS is describing the change as both raising the standard for
nursing facilities and also providing meaningful differences among facilities to benefit the
consumers who use of the star rating system. Those star -- those consumers are concerned about
every Medicare beneficiary and the care they received. CMS, when they did this change
expected that about two thirds of the nursing homes saw a decline in their quality measure
ratings and about one third of nursing homes saw a decline in their overall five-star rating
system. Before the recalibration about 80% of all nursing facilities received four or five stars to
the quality measure rating. That has changed. So let's review the overall nursing home rating ,
just to get an idea of what is included in that. Every nursing home has an overall nursing home
rating and a star rating for three domains. Health inspection, staffing and quality measures. The
health inspections rating is heavily weighted and heavily weighted because it is the only domain
in which currently is not using data that is self-reported from the nursing home. The additional
domain, including staffing, which focuses on nursing staffing, CNA's LPNs and are ends in the
final one is your quality measure rating based on 11 of the 18 quality measures reported on
nursing home compare. What does that mean? Quite simply it means that every quality measure
listed on nursing home compare is not concluded -- included in the five star there are a loving
measures are included.
Now, if this is new to you you might be asking where does this quality measure data come from?
It is developed from the MDS data. Quality measures are calculated from the state and once
again it is the data used to that. The measure addresses a broad range of functioning and health
status and multiple care areas. Now, one additional aspect, if you if you read the technical user's
guide you will find out that the ratings for the quality measure domain are calculated using the
three most recent quarters for which data are available. This time period specification was
selected to increase the number of assessments available for calculating the quality measure
ratings, increasing the stability of the estimates and reducing the amount of missing data. This is
not current data posted right now on Nursing Home Compare, it reflects six months ago.
Taken from resources at CMS, this slide is helpful for you to identify how your overall rating is
calculated. It is critical now to know that your health inspection rating serves as the base or core
and we explained why because this is the only data at this time that nursing homes do not selfreport. You start with the health inspection rating and you see what your score is. This core score
is adjusted up , meaning that if you gain a star if it can increase its star if the facility received a
five-star rating for it quality measure domain so you get a star added to your overall score. The
core score is adjusted up for staffing in two situations. One, if you receive a five-star rating for
staffing and in some cases, if you receive a four star rating, but this can only occur if the four star
rating you receive on staffing is higher than your core score on the health inspection rating.
I would like to draw your attention to what I consider the danger zone and that is at the bottom of
the slide where it it -- where it talks about where you can subtract a star. We talked about how
you can add a star, but you also can lose a star from your health inspection rating. And those are
in the areas of staffing and quality measures. You receive a one star in either staffing or quality
measures, it can take away from your base score which is your health inspection rating. A two on
the quality measures puts you in the danger zone. Of going to a one, which could ultimately
affect your rating. So, how do you know your rating? It is hard to keep up with , if you try to
keep up with scoring for five-star quality measures it requires you to visit several CMS website,
make sure you intimately understand the technical user's guide and cross reference certain data
on the CMS website. To health you with this, CMS provides nursing homes with a provider
rating report that they often refer to as the preview report. It would be interesting now to find out
how many of you are familiar with the provider rating report. If you wouldn't mind, please enter
in the text if you have not heard of your provider rating report. And we will see how many
people have not heard about that. The five-star preview report is made available to every nursing
home as an opportunity to see what is going to be publicly reported on the CMS website. It
comes out usually two weeks before the public posting of your new star rating.
It is made available, and the most recent report was updated June 15. This report occurs monthly.
To access these reports, you have to select a Casper reporting link on the key system for the
providers page. You then have to go to the boulders option. This is a lot to write down. You can
contact your Telligen quality improvement coordinator to provide you more information on
accessing your provider rating report if you don't receive its. So, if we look at that provider rating
report you will see on the example we have here, this particular facility has an overall rating of
three stars. They have a health inspection rating of three stars. That rating is similar to your
overall quality rating. You have a quality measure score of two and as staffing score of three. To
be able to bump up your health inspection rating star into your overall quality you would need
five stars in the quality measures or four stars in the staffing. Information on the RAN staffing is
useful for you to know but it is not included to bump up the rating on your overall score. This is
a copy of the second page, a little smaller for you to see, but demonstrates the information CMS
provides to you in your mailbox on which quarters are included in the calculations for your
quality measures.
The document will list each particular quarter and it will give you a three quarter average so that
you can see the data that CMS is using. If perhaps you don't have access to that report, another
option you have is the database that reflects all of the data you see on Nursing Home Compare
and that is at data.medicare .gov. You can pull the current files that we have listed here for you to
see what your quality measure ratings were to identify your scores if you want to double check
them. It is easier with the preview report. So far we have suggested that CMS will continue to
require publicly reported data to drive quality. We have provided a brief overview of the five-star
calculation scoring and now we will break down the quality measure a little bit further. Why?
Because you can monitor and you can manage, to some extent, the outcomes for your residence
specific to each quality measure. You know your strengths, weaknesses and opportunities in
terms of the quality measures, included in this five-star rating. Now it is kind of interesting, to
prepare for this call I compared each state's Colorado, Illinois , and Iowa, number of of nursing
homes he received a one star rating for the quality measure domain, posted in January 2015 and
compared it to February of 2015. Using data that I found on data at Medicare .gov on the
previously. Colorado wet from two nursing homes to 16 at risk are -- that received a score, Iowa
went from seven to 46 and ill Italy in Christ -- and Illinois increased I think this deserves our
attention. So quick preview on the quality measures included in the calculation for the five-star
rating. The facility rating for the quality measure domain is based on performance on a subset of
11 out of the 18 quality measures you see on Nursing Home Compare.
The measures were selected based on their validity and reliability and to the extent to which
facility practice may affect the measure. As of February, 2015 , two measures for the
antipsychotic medications, one for short stay and one for long stay have been incorporated into
the five-star rating system. You can see those because we highlighted them. I think these have
largely impacted the overall quality measure scores for facilities. Now, I want to present to you
an overview of a tool that Telligen has designed to assist nursing homes with calculating the
five-star quality measure rating rating. We feel this tool is going to be helpful because prior to a
tool like this, you would have to gather a lot of information to calculate your scores by hand or
maybe on an Excel spreadsheet. You would have to have your preview report. You would have
to have the technical user's guide. You would have to, in the technical user's guide, flip pages to
identify your rating. This becomes very cumbersome and we have it in a one-stop shop. This
tool, we have one for each state participating on this call, Colorado, Iowa and Illinois will have
their own version. And it is not interchangeable because we have to use the state averages as a
default when, in a few cases, the denominator may be too small to calculate. That is according to
the rules in the CMS technical user's guide for the five-star rating. We want to be able to reflect
that. You currently see an example of the calculation tool for Iowa, when you receive one, if you
request from your quality improvement facilitator from tran01, you have to make sure that you
receive the one for your states. I also would like you to take a look at the bottom of this slide
slide. You will see this is an Excel spreadsheet. There are several tabs or worksheets on the
bottom, how it is designed, very similar very similar to the advancing excellent tool.
You are looking at the title page, then and instructions page, a star rating which will do your
calculation and a reference for your state average. This tool is intended to health you determine
the point value assigned to each three quarter average quality measure score and will calculate
the total score number of stars for the quality measure domain for you. This is an example of the
second worksheet with the instructions you can use to step by step understand this tool. This is
the final worksheet , ahead of its time, which will reference each state's three-quarter average for
each quality measure. I will give you a minute to look at this and that we will bring it up if I can - if I am technically savvy enough to do this. This is the tool we believe will be most helpful to
you. The worksheet you have been waiting for. Take a moment and take a look at this tool and I
will try to bring a larger version of this tool up. Here is the larger version of the tool. I am just
going to reach out to Cheryl who works with me on the call. If you can verify you have a good
view of this tool?
I do, it looks good.
She will be helping me get back to my PowerPoint screen if I fell after we review this. But here
is the worksheet and we are going to go column by column. On an Excel spreadsheet we have
column ABCD starting left moving to the right. The quality measure shows the measures used in
the calculation of the Nursing Home Compare five-star rating. The three quarter average is to be
populated with your nursing home's three-quarter average percentages that you will gather from
your putrid -- from your preview report. The numeric values will include numbers zero to 100
numeric values outside of this range and nonnumeric entries including spaces are invalid entries
which will disable the calculations. You can read more about those in the instructions. And the
next column, the AQM percentage from displays of the lower bound percentage from each
quality measure point value that is how CMS assigns the points so they have a range of points a
range of quality measure scores assigned points. The quality measure percentage two displays
the upper bound percentage of each quality measure point value. As we move on it will calculate
them for you, the quality measure points, the quality measure points displays the point value for
each quality measure percentage range.
Your quality measure point column displays the point value calculated for your nursing home by
the quality measure. When dealing this electronically, you need to know that until the values for
at least four of the long stay or two up a short stay measures are entered in column B, it is not
going to display. It will stay as an A but the more data you put in you will start seeing the points.
The actual points displays one of four values. Actual, imputed, not available not available or
invalid entries. Note that until values for at least the four long stay in two short stay measures are
included, it is going to state remaining at any -- NA and my favorite piece outside of doing math
the table displays the lower and upper bound point values and associated five-star quality
measure rating.
Below that displays your nursing home's total points and five-star quality measure ratings as
determined by the values entered into column B. The bottom table displays the count of entries
in column B by type blog say, short stay, missing, missing or invalid. So as you can see, we have
three quality measure averages, I don't know why I took their team but it is going to be 13 , we
don't see anything in the rose F and G points for quality measures for urinary tract infections I
am going to enter 3.0. Now, if you look, I have entered 4 and oh my goodness, under the quality
measure percentage from 2 I have scored the least amount of points and I will draw my attention
to that because it highlights it in red. Move across to column F you see your point you achieved ,
24 injury injury is false, 20.4 Payne 20 points for high risk pressure ulcers, I am doing pretty
good 3.0 I have 80 points over if you look to your far right we haven't entered all of the
categories but you have 468 points. You are a one star. If we were to now be really optimistic
and say I am just doing fantastic in every area remaining, I will put zero's meaning that these do
not occur for a three-quarter average in my nursing home and I have completed all of this. I am
moving up and even though I started out a little weak in our hypothetical situation you will see
we have scored a total of 840 points. That is the range of five stars. Exciting. Again this is a new
tool. We are using this tool for all of the nursing homes in there as well over 500 who have
joined our collaborative. Your quality improvement facilitators can health you use this tool.
We are hoping this is a time-saving tool that can health you leap into an improvement
opportunity. As you know, working with Telligen it really is all about quality assurance
performance improvement. As the foundation for any improvement initiatives. Your public
image with your five-star rating is a quality assurance improvement agenda item for sure.
Quality measures that continuously drive your five-star rating down are ripe for a performance
improvement project. Our collaborative his action oriented. We are looking to share information
amongst each other and get some type of result that we can do tomorrow. We are going to
challenge you, what can you do next. Pull your last preview report or if you haven't used your
Peavy report find out how to get them. Fill it in. See where you are at. Compare your self to a
previous quarter. Put a PDSA, plan, do, study, act into action. We also want to suggest a couple
other very creative ways to use this report that we are using. The first one is validate your current
rating. What goes on that public website is important to you right now because it stays up there
for a long time, for the whole world to see. A world of potential consumers, a world of potential
staff and hospitals. Use it first to validate your rating. You can also, those of you who are pretty
good with math and frequently review your CASPER reports, you may project where you can be
next quarter. You can look at your reports and find out where you are today, to health you focus
on areas which may be improvement. For example, the function of the tool that highlights the
quality measure when you are receiving the least amount of points, that might be helpful to start
a conversation with a quality improvement team. We are hoping this will health. That is the
conclusion of the presentation and we will open it up for questions.
Up this time if you would like to ask a question, please press star then the number one on your
telephone keypad.
This is Sheryl Marshall. Would you bring the tool backup, that slide.
This slide or the tool?
The actual tool would be fine, too. What ever works best.
Here is the tool. By showing the tool, I can't see any of the chat. So if there are any questions, we
know that Jessica will health us with the questions. If there are any questions in the chat, I ask
that Sheryl share those with the.
We have a question from over the phone the first question comes from Rhonda Hancock, your
line line is open.
Rhonda?
I am sorry we don't have any questions.
Great to hear from you I hope you are having a good day.
Thank you, Lisa, you too.
Again, if you would like to ask a question please press star and the number one on your
telephone keypad.
This is Sheryl I will share until there is more questions, operator, go-ahead and and interrupt if
you want to. Lisa, I wanted to point out one thing on road 28 when we look at physical restraints
, I think it is really interesting to know that the physical restraint measure and I believe the
pressure ulcer measure let's talk about physical restraint measure. Notice that there is only three
rows when it comes to the number of points you can get. You will either get 20, 60 or 100. So
the point I want to make is, if you have no physical restraints in your building, you automatically
get 100 points. But, if you even have just one, I don't care care if your senses is 3000, if you have
one restraint you lose 30 points just like that -- if you're census is 3000 -- I want want to point
that out if folks are considering being restraint free this is a really important thing to consider.
CMS realized that the restraints, number of homes that have restraint is so low they did not need
five categories anymore. So I just wanted to point that out.
Thank you. Any questions in chat?
Susan asks, could you please specify how to get the preview report? Thanks.
You can get the preview report by -- you have to go to the key system. I will see if I can find the
slide for that. I know in chat we put the link to where you can get the preview report or request it.
I don't think I have a slight on the preview report but I think somewhere in the chat I saw the
location of the preview report and we typed in the web address, correct?
Yes I just entered it again.
You might want to look in the chat and you can link on to that website.
If you have any more questions let me know, this is Sheryl.
It is the CMS key system for providers page. Any other questions? Your time is valuable and we
respect that. You have all our contact information , as you should. If you have additional
questions when you start pondering this, so we encourage you to ask questions. This is your
nursing home team across the three states, it is our greatest pleasure to be able to health you with
this. We believe this is really going to health. If you want a copy of the tool you need to contact
your facilitator from your states. I think with that being said I would like to thank Sheryl and
Nell for helping me Manning the chat and if there are no other questions I propose we end this
call and wish everyone a really good weekend. Thank you, everyone.
This concludes today's conference call, you may now disconnect. [Event concluded]