2017 Long-Term Care Facility Quality Improvement Program (LTC QIP) Kick Off Webinar Date: January 11, 2017
Audio Instructions To avoid echoes and feedback, we request that you use the telephone instead of your computer microphone for listening/talking during the webinar.
Introductions & Contact Information QIP Team Members - Fairfield and Redding Website: http://www.partnershiphp.org/Providers/Quality/Pages/ LTC_QIP/Long-Term_Care_QIP.aspx Email: LTCQIP@partnershiphp.org Fax: 707-863-4316
Overview I. Background II. Program Year 2016 Summary III. Program Structure IV. Measurement Year 2017 V. Next Steps VI. Q&A
I. Background - PHC Mission: To help our members, and the communities we serve, be healthy - Serves over 550,000 Medi-Cal members in 14 counties through local care providers - Strategic focus areas: High quality health care, operational excellence, financial stewardship - Quality Improvement Programs (QIPs) in primary care, hospital care, specialty care, and community pharmacy - Over 70 contracted long-term care facilities
I. Background LTC QIP Guiding Principles 1. Where possible, pay for outcomes instead of processes 2. Actionable Measures 3. Feasible data collection 4. Collaboration with providers in measure development 5. Simplicity in the number of measures 6. Representation of different domains of care 7. Align measures that are meaningful 8. Stable measures
II. Program Year 2016 Summary - Just wrapped up our first year! 2016 Part II data submissions due February 28 th - - Change to payment process – no longer to be billed as a withhold (details in next section) - Payment to be sent in April 2017
III. Program Structure Eligibility Requirements - Contracted with PHC through December 31, 2017 - Sign Letter of Agreement by December 15, 2016 - Good standing with state and federal regulators
III. Program Structure Timeline Final payment for QIP 2017 Measurement year 2017 mailed January 1, April 30, August December February April 30, 2018 2017 2017 31, 2017 31, 2017 28, 2018 Final payment Part I Data Final date for for QIP 2016 Submissions Due data submissions mailed
III. Program Structure Payment Methodology - Separate and distinct from usual reimbursement - 2% of average annual payment - Compete independently of other facilities - Determined by PHC member volume and performance on quality measures
IV. Program Structure Payment Methodology: Example A B C D E F Number of PHC Annual Payment Potential QIP Score QIP Dollars Custodial ($224 per Earning Pool (out of Earned Members custodial (Annual 100) (assume the member per day payment*2%) same number on average) for all 365 days) LTC Facility 1 20 $1,635,200 $32,704 45 points $14,716 LTC Facility 2 10 $817,600 $16,352 90 points $14,716 LTC Facility 3 50 $4,088,000 $81,760 90 points $73,584
Measurement Set 2017 - No changes from 2016 measurement set - Developed in collaboration with long-term care facility representatives - Approved by PHC’s Physician Advisory Committee - Simple, yet comprehensive - Data reporting burden is light - Measures add up to 100 points - 10 measures, in 4 domains
Measurement Set 2017 CLINICAL % of high-risk residents with pressure ulcers (10 pts) % of residents who lose too much weight (5 pts) % of residents with diagnosis of dementia with feeding tube in place (5 pts) FUNCTIONAL STATUS % of residents experiencing one or more falls with major injury (10 pts) % of residents who have/had a catheter inserted and left in their bladder (10 pts) RESOURCE USE Transfers resulting in admission to hospital as an inpatient (10 pts) Transfers resulting in ED visit only (10 pts) OPERATIONS/SATISFACTION Results of last CMS audit (15 pts) Implementation plan for INTERACT 4, Advancing Excellence, or QAPI program (10 pts) QI Training by Health Services Advisory Group (HSAG) (15 pts)
Measurement Set 2017 Specifications: 2017 Measure Specifications Found on our Program Page: LTC QIP 2017
Measurement Set 2017 Measure Submission Required Submission Threshold* Due Date CLINICAL % of high-risk No; based on Nursing N/A Lower or equal to residents with Home Compare data 5.7% pressure ulcers extracted February 2018 % of residents who No; based on Nursing N/A Lower or equal to lose too much Home Compare data 7.0% weight extracted February 2018 % of residents with Yes August 31, None; pay for dementia diagnosis 2017 reporting with feeding tube in February 28, place 2018 * All clinical and functional measure thresholds come from Nursing Home Compare, which compares all Medicare- and Medicaid certified nursing homes in the country.
Measurement Set 2017 Measure Submission Required Submission Threshold* Due Date FUNCTIONAL STATUS % of residents No; based on Nursing N/A Lower or equal to experiencing one Home Compare data 3.3% or more falls with extracted February 2018 major injury % of residents who No; based on Nursing N/A Lower or equal to have/had a Home Compare data 2.8% catheter inserted extracted February 2018 and left in their bladder * All clinical and functional measure thresholds come from Nursing Home Compare, which compares all Medicare- and Medicaid certified nursing homes in the country.
Measurement Set 2017 Measure Submission Submission Due Threshold Required Date RESOURCE USE Transfers resulting in Yes August 31, 2017 None; pay for admission to February 28, 2018 reporting hospital as inpatient Transfers resulting in Yes August 31, 2017 None; pay for ED visit only February 28, 2018 reporting OPERATIONS/SATISFACTION Results of last CMS No; based on N/A Most recent CMS audit Nursing Home stars rating with 4 Compare data or above for full extracted February credit, 3 or 3.5 for 2018 half credit * All clinical and functional measure thresholds come from Nursing Home Compare, which compares all Medicare- and Medicaid certified nursing homes in the country.
Measurement Set 2017 Measure Submission Required Submission Due Threshold Date OPERATIONS/SATISFACTION Implementation Yes August 31, 2017 None, pay for plan for INTERACT and February 28, reporting 4 or Advancing 2018 Excellence, or QAPI program QI Training by Yes February 28, 2018 None, pay for Health Services reporting Advisory Group (HSAG) * All clinical and functional measure thresholds come from Nursing Home Compare, which compares all Medicare- and Medicaid certified nursing homes in the country.
V. Next Steps Bookmark PHC’s LTC QIP webpage Check back for HSAG training dates Mark your calendar for submission deadlines 2016 Sites: Data due 2/28!
Questions? If you have a question or would like to share your comments, please Type your question in the • “question” box, or Click the “raise your hand” icon •
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