Medicare Introduces Innovations to
Improve Post-Acute Care
Nursing Home Five-Star rating
expands, conditions for participation by home health agencies
7, 2014 – Two new initiatives to improve the quality of post-acute care
in Medicare were announced yesterday by the Centers for Medicare &
Medicaid Services (CMS). First, the agency’s widely-used Five Star
Quality Rating System for Nursing Homes will be expanded to improve
consumer information about individual nursing homes’ quality. Secondly,
proposed new conditions for home health agencies will modernize
Medicare’s Home Health Agency Conditions of Participation to ensure safe
delivery of quality care.
“We are focused on using as many
tools as are available to promote quality improvement and better
outcomes for Medicare beneficiaries,” said Marilyn Tavenner, CMS
administrator. “Whether it is the regulations that guide provider
practices or the information we provide directly to consumers, our
primary goal is improving outcomes.”
Beginning in 2015, CMS will
implement the following improvements to the Nursing Home Five Star
Quality Rating System:
Nationwide Focused Survey
Inspections: Effective January 2015, CMS
and states will implement focused survey inspections nationwide for a
sample of nursing homes to enable better verification of both the
staffing and quality measure information that is part of the
Five-Star Quality Rating System. In Fiscal Year (FY 2014), CMS
piloted special surveys of nursing homes that focused on investigating
the coding of the Minimum Data Set (MDS), which are based on resident
assessments and are used in the quality measures.
Reporting: CMS will implement a quarterly
electronic reporting system that is auditable back to payrolls to verify
staffing information. This new system will increase accuracy and
timeliness of data, and allow for the calculation of quality measures
for staff turnover, retention, types of staffing, and levels of
different types of staffing. Implementation will be improved by funding
provided in the recently enacted, bipartisan Improving Medicare
Post-Acute Care Transformation Act (IMPACT) of 2014.
Additional Quality Measures:
CMS will increase both the number and type of quality measures used in
the Five-Star Quality Rating System. The first additional
measure, starting January 2015, will be the extent to which
antipsychotic medications are in use. Future additional measures will
include claims-based data on re-hospitalization and community discharge
Timely and Complete
Inspection Data: CMS will also strengthen
requirements to ensure that States maintain a user-friendly website and
complete inspections of nursing homes in a timely and accurate manner
for inclusion in the rating system.
Improved Scoring Methodology:
In 2015, CMS will revise the scoring methodology by which we calculate
each facility’s quality measure rating, which is used to calculate the
overall Five Star rating. We also note that sources independent
of self-reporting by nursing homes already are weighted higher than
self-reported components in the scoring methodology.
“Nursing homes are working to
improve their quality, and we are improving how we measure that
quality,” said Patrick Conway, M.D., deputy administrator for innovation
and quality and CMS chief medical officer. “We believe the improvements
we are making to the Five Star system will add confidence that
the reported improvements are genuine, are sustained, and are benefiting
Home Health Conditions of
The proposed Home Health Conditions
of Participation would improve the quality of home health services for
Medicare and Medicaid beneficiaries by strengthening patient rights and
improving communication that focuses on patient wellbeing. Currently
there are more than 5 million people with Medicare and Medicaid benefits
that receive home health care services each year from approximately
12,500 Medicare-certified home health agencies.
The proposed regulation, to be
displayed Monday, October 6, at the Federal Register, would
modernize the home health regulations for the first time since 1989 with
a focus on patient-centered, well-coordinated care.Elements in
the regulation include expansion of patient rights requirements;
refocusing of the patient assessment on physical, mental, emotional, and
psychosocial conditions; improved communication systems and requirements
for a data-driven quality assessment; and performance improvement (QAPI)
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