new mary dalrymple managing director, ltrax ltrax... · 2019. 3. 19. · patients assessed for...
TRANSCRIPT
New Outcome Measures
Mary Dalrymple
Managing Director, LTRAX
Objectives
Review and discuss newly added outcome measures
Pressure Ulcers
• New or Worsened Unstageable (all types)
• Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)
• Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
Drug Regimen Review
Spontaneous Breathing Trial
• Invasive Ventilator Weaning Admissions
• Assessed for Readiness for SBT by Day 2
• Deemed Ready for SBT by Day 2
• Ready and Received SBT by Day 2
New or Worsened Pressure Ulcers: Unstageable
Purpose
Visibility into Medicare’s roll-up for public reporting
Measures
How many assessments reported new or worsened pressure ulcer(s) of the itemized type?
• Unstageable: Nonremovable Dressing
• Unstageable: Slough/Eschar
• Unstageable: Deep Tissue Injury
Details
Measure has an assessment basis
• Each new Admission Assessment is counted as a new admission
Weighted for case-mix comparisons
Not a sum of new or worsened pressure ulcers at each stage
New or Worsened Pressure Ulcers:Unstageable
Numerator
Count of assessments where reported New or Worsened Pressure Ulcers at the selected stage is ≥ 1
• Until 7/1/18, “new or worsened” defined by data reported in M0800
• Beginning 7/1/18, “new or worsened” defined as pressure ulcers present on discharge but not present on admission
Calculated in the New or Worsened column on SKIN tab
Denominator
Planned and Unplanned Discharge transmissions
• Expired Assessments excluded
• Assessments missing Section M. Skin Conditions data excluded
NQF #0678 – New or Worsened (Stages 2, 3 or 4)
Purpose
Replicate Medicare’s measure for public reporting of Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)
Measures
Observed Score: How many assessments reported at least one new or worsened pressure ulcer of the selected stages at discharge?
Details
Measure has an assessment basis
• Each new Admission Assessment is counted as a new admission
In use until LTCH CARE v. 4 on 7/1/18
Weighted for case-mix comparisons
NQF #0678 – New or Worsened (Stages 2, 3 or 4)
Numerator
Patients discharged before 7/1/18
Any of M0800 A, B or C on the discharge assessment ≥ 1
• Assessment only counted once even if new or worsened pressure ulcers are reported in more than one stage
Denominator
Planned and Unplanned Discharge transmissions
• Expired Assessments excluded
• Assessments missing Section M. Skin Conditions data excluded
Important
Only Stages 2, 3 or 4
This measure ends on 7/1/18
• Replaced by Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/ Injury
NQF #0678 – New or Worsened (Stages 2, 3 or 4)
Percent of Patients with Pressure Ulcers that are New or Worsened (Stages 2, 3 or 4) (NQF #0678)
1.2% - national average
0% to 12% - range among hospitals
New or Worsened by Stage
1. Stage 2 – 0.6% average
2. Stage 3 – 0.4% average
3. Stage 4 – 0.3% average
Time Period: 7/1/17 – 6/30/18 (last 12-month reporting period)
Changes in Skin Integrity
Purpose
Replicate Medicare’s measure for public reporting of Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
Measures
Observed Score: How many assessments reported at least one new or worsened pressure ulcer of any type at discharge?
Details
Measure has an assessment basis
• Each new Admission Assessment is counted as a new admission
In use beginning with LTCH CARE v. 4 (7/1/18)
Weighted for case-mix comparisons
Changes in Skin Integrity
Numerator
Patients discharged 7/1/18 and later
≥ 1 pressure ulcer of any type reported on the discharge assessment that was not reported on the admission assessment
• Assessment only counted once even if new or worsened pressure ulcers are reported in more than one stage
Denominator
Planned and Unplanned Discharge transmissions
• Expired Assessments excluded
• Assessments missing Section M. Skin Conditions data excluded
Important
All stages
Beginning 7/1/18
Changes in Skin Integrity
Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
2.62% - national average
• Double the national average when only reporting Stages 2, 3 or 4
0% to 15% - range among hospitals
New or Worsened by Stage
1. DTI – 0.79% average
2. Unstageable: Slough/Eschar – 0.75% average
3. Stage 2 – 0.61% average
Time Period: 7/1/18 – 2/26/19 (all available data)
Pressure Ulcers
Change in Pressure Ulcer Measures
Increased rates under new measure
Increase driven by DTIs & Slough/Eschar
Both measures risk-adjusted
• In LTRAX, gap between your hospital and weighted national or regional average could indicate opportunity for improvement
2018 transitional year
• In LTRAX, new or worsened breakdowns span calendar 2018
• On LTCH Compare, the two pressure ulcer measures will not be publicly reported on the website at the same time
NQF measure will be publicly reported until new quarterly data is no longer available to report
Changes in Skin Integrity will be publicly reported by Oct. 2020
Drug Regimen Review
Purpose
Reflect Medicare’s calculations of publicly reported measure
Measures
Observed Score: How many patients meet all requirements for a complete drug regimen review and appropriate follow-up for potentially significant issues?
Details
7/1/16 and later
Measure has an assessment basis
• Each new Admission Assessment is counted as a new admission
Not risk-adjusted
Higher is better
Drug Regimen Review
Numerator
A drug regimen review conducted at admission
• N2001. Drug Regimen Review not skipped
If potentially significant clinical issues were found, a physician or designee was contacted and recommended actions were taken by midnight of the next calendar day
• If N2001 = Yes, then N2003 must = Yes
Throughout the visit, a physician or designee was contacted and recommended actions were taken by midnight the next calendar day every time a potentially significant medication issue was identified; or, no issues occurred during the patient’s visit
• N2005 = Yes or NA
Denominator
Discharge transmissions
Important
Looks back to admission, so no recovery possible at discharge
Drug Regimen Review
Drug Regimen Review Conducted with Follow-Up for Identified Issues
79.2% - national average
• Higher is better
0% to 100% - range among hospitals
• Bimodal pattern suggests some hospitals may be misinterpreting and/or facing implementation challenges
Time Period: 7/1/18 – 2/26/19 (all available data)
Spontaneous Breathing Trial
Purpose
Reflect Medicare’s calculations of publicly reported measures
Measures
Invasive Ventilator Weaning Admissions: How many patients did we admit as invasive vent weaning patients?
Assessed for Readiness by SBT for Day 2: How many vent weaning patients were assessed for readiness for SBT by day 2?
Deemed Ready for SBT by Day 2: How many vent weaning were deemed medically ready for SBT by day 2?
Ready and Received SBT by Day 2: How may patients ready for SBT received SBT by day 2?
Details
7/1/16 and later
Measure has an assessment basis
• Each new Admission Assessment is counted as a new admission
Not risk-adjusted
SBT: Invasive Ventilator Weaning Admissions
Numerator
Patients admitted on invasive ventilator and identified as weaning candidates
• O0150A. Invasive Mechanical Ventilation Support at Admission = Yes, weaning
Denominator
All discharge transmissions
Important
Identical to the measure used to identify pool of admissions used in Ventilator Liberation Rate measure
This measure identifies denominator for first of two Medicare publicly reported SBT measures
SBT: Assessed for Readiness for SBTby Day 2
Numerator
Patients assessed for readiness for SBT by day 2
• O0150B. Assessed for readiness for SBT by day 2 of the LTCH stay = Yes
and
• O0150C Deemed medically ready for SBT by day 2 of the LTCH say = Yes
or
• O0150D. Is there documentation of reason(s) in the patient’s medical record that the patient was deemed medically unready for SBT by day 2 of the LTCH stay? = Yes
Denominator
Invasive Ventilator Weaning Admissions
Important
Patient cannot be counted as assessed if documentation of unreadiness is not in the medical record by day 2
Higher is better
SBT: Deemed Ready for SBT by Day 2
Numerator
Patients deemed ready for SBT by day 2
• O0150C. Deemed medically ready for SBT by day 2 of the LTCH stay = Yes
Denominator
Assessed for Readiness for SBT by Day 2
Important
Denominator for second of two Medicare publicly reported SBT outcome measures
SBT: Ready and Received SBT by Day 2
Numerator
Patients who received SBT by day 2
• O0150E. SBT performed by day 2 of the LTCH stay = Yes
Denominator
Deemed Ready for SBT by Day 2
Important
Higher is better (within clinical appropriateness)
Spontaneous Breathing Trial
Assessed for Readiness for SBT by Day 2
89.6% - national average
• Higher is better
0% to 100% - range among hospitals
• Many hospitals in 90’s or at 100%
Ready and Received SBT by Day 2
97.7% - national average
• Higher is better
0% to 100% - range among hospitals
• Virtually all hospitals > 50%
• More than 80% of hospitals in the 90’s or at 100%
Time Period: 7/1/18 – 2/26/19 (all available data)
LTCH QRP Measures
Expectations and comparisons
LTRAX outcomes will show you raw and/or weighted national comparisons so you know how you compare to other LTCHs.
LTRAX offers similar regional comparisons (see HELP screen for details about your region).
If in an organization, LTRAX can compare your performance to your organization as a whole.
LTRAX will reflect the raw or unadjusted calculations of publicly reported measures.
• Medicare will risk-adjust based on their published methodology.
• LTRAX weighting gives you an apples-to-apples comparison but does not match Medicare’s risk adjustment.
Resources
LTRAX Outcomes Help Documentation
https://www.ltrax.com/help/OutcomesHelpLTRAX.htm
LTCH QRP Measure Calculations and Reporting User’s Manual v.3
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/LTCH-Measure-Calculations-and-Reporting-Users-Manual-V30.pdf
Questions?