AgeNet-OASN Managed Care Metrics
Presented By
Colleen Lavelle and Cindy Saunders, Jennings Center for Older Adults
and
Barb Barnette, Saint Augustine Manor
May 14, 2014
AgeNet-OASN Managed Care Metrics
• Quality committees of AgeNet and OASN
reevaluated and made changes to the
LeadingAge managed care metrics to:
- Improve data consistency
- Streamline data collection
- Retrieve data from reliable/validated tools
AgeNet-OASN Managed Care Metrics
• New metrics to be reported on the cPMT
website beginning July 15, 2014.
• If new to cPMT, AgeNet or OASN chairs will
assist you in how to use the website
• cPMT reports will enable benchmarking
among AgeNet and OASN members
• Identify and share best practices
AgeNet-OASN Managed Care Metrics
• Metrics critical to demonstrate to payers and
other potential partners proven quality
• Essential to pay for performance and other
value based reimbursement arrangements
going forward
• Selected measures are a place to start
• Will need to be fluid as health care delivery
reform evolves
Monthly Metrics Reporting
Metric
1. Nursing Staff Hours
per resident day
(Short Term Skilled
and Long Term Care)
1.a Nursing Staff Hours
per resident day
(Short Term Skilled
Only)
2. RN Staff Hours per
resident day (Short
Term Skilled and
Long Term Care)
2.a RN Staff Hours per
resident day (Short
Term Skilled
Report Date
The 15th of the second
month following the
review period.
Example: May 1 -31
review month reported
July 15th.
Guidance
• Includes direct and
indirect nursing staff
• Actual hours worked
• If no distinct SNF unit,
1.a and 2.a would be
-0-
Monthly Metrics Reporting
Metric
3. 30 Day Unplanned
Readmission Rate
(Short Term Skilled
Only)
3.a 30 Day Unplanned
Readmission Rate
(Long Term Care Only)
Report Date
The 15th of the second
month following the
review period.
Example: May 1 -31
review month reported
July 15th.
Guidance
• Hospitalization
tracking tool will
automatically calculate
• Follows
patients/residents
admitted in the review
month for 30 days
(delayed reporting)
Monthly Metrics Reporting
Metric
4. Unplanned
Observation Stay Rate
(Short Term Skilled
Only)
4.a Unplanned
Observation Stay Rate
(Long Term Care Only)
Report Date
The 15th of the second
month following the
review period.
Example: May 1 -31
review month reported
July 15th.
Guidance
• Hospitalization
tracking tool will
automatically calculate
• Adjusted for census
and number of days in
month in order to
benchmark
• Expressed in terms of
1,000 resident days
(e.g., 3 observation
stays per 1,000
resident days or 3
observation stays every
10 days)
Monthly Metrics Reporting
Metric
5. Emergency Room
Visit Rate (Short
Term Skilled Only)
5.a Emergency Room
Visit (Long Term Care
Only)
Report Date
The 15th of the second
month following the
review period.
Example: May 1 -31
review month reported
July 15th.
Guidance
• Hospitalization
tracking tool will
automatically calculate
• Adjusted for census
and number of days in
month in order to
benchmark
• Expressed in terms of
1,000 resident days
(e.g., 3 emergency
department visits per
1,000 resident days or
3 emergency
department visits
every 10 days)
Monthly Metrics Reporting
Metric
Report Date
10. Return to Community The 15th of the second
(Short Term Skilled
month following the
Only)
review period.
Example: May 1 -31
review month reported
July 15th.
Guidance
• Numerator includes
return to AL and IL
• Denominator includes
all who became
unskilled for any
reason including death
Quarterly Metrics Reporting
Metric
6. Falls With Major
Injury (Long Term
Care Only)
7. High-Risk Pressure
Ulcers (Long Term
Care Only)
8. UTI’s (Long Term Care
Only)
9. New/Worsening
Pressure Ulcers
(Short Term Skilled
Only)
Report Date
Last day of the month
that follows the review
period.
Example: Jan-March
review period data is
entered on April 30th
Guidance
• Obtain data from
quarterly CASPER
report
Quarterly Metrics Reporting
Metric
Report Date
11. Patients/Residents
who were assessed
and appropriately
given the flu vaccine
(Short Term Skilled
and Long Term
Care)
12. Patients/Residents
who were assessed
and appropriately
given the
pneumococcal
vaccine (Short Term
Skilled and Long
Term Care)
Last day of the month
that follows the review
period.
Example: Jan-March
review period data is
entered on April 30th
(Use the most recent
data available on April
30th even if for an
earlier quarter)
Guidance
• Obtain data from
Nursing Home
Compare Website
Five Star Report
Hospitalization Tracking Tool
• Utilize the INTERACT or Advancing Excellence
Hospitalization Tracking Tool (virtually the same tool)
to report 30-day readmission, emergency department
visit and observation stay visit rates
• The INTERACT/Advancing Excellence Hospitalization
Tracking Tool is designed to:
- Provide clear hospitalization rate definitions
consistent with evolving definitions used by CMS
and other national organizations
- Utilization of this tool will ensure accurate and
consistent reporting in the cPMT website
Hospitalization Tracking Tool
• INTERACT/Advancing Excellence tool reports
hospitalization rates but is also used for
quality improvement
• Today, we will be focusing on those portions of
the tool that need to be completed for
reporting hospitalization rates