Expert panel recommends functional status quality measures for skilled nursing facilities

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Expert panel recommends functional status quality measures for skilled nursing facilities
Expert panel recommends functional status quality measures for skilled nursing facilities

An expert panel convened by federal regulators has offered recommendations for functional status quality measures in skilled nursing facilities. Released Friday was a summary of the experts' advice to create a functional status quality measure in SNFs, as well as inpatient rehabilitation facilities and long-term care hospitals.

The panel also announced that it had decided against recommending that items from Section G of the Minimum Data Set be used to determine a restorative goal. 

The Centers for Medicare & Medicaid Services contracted with nonprofit research organization RTI International to convene the experts, including rehabilitation clinicians, administrators and researchers.

The discussion centered on the use of items from the Continuity Assessment Record and Evaluation (CARE) set, which was developed as part of a demonstration project to standardize assessments across different post-acute settings. Specifically for SNFs, the experts examined four outcome measures: the change in self-care and change in mobility scores for medical rehabilitation patients, and the discharge self-care and discharge mobility scores for these patients.

Most CARE mobility and self-care items already are assessed in SNF settings, as well as in IRFs, the experts noted. However, “challenging mobility activities” such as car transfers are not routinely assessed in these settings. Assessing these abilities is important for residents who are returning home or to a community-based setting, they concluded.

The panel also addressed risk adjustment. Individuals who have an incomplete stay — including those who die or are unexpectedly transferred to a hospital — should not be included in calculating the quality measure, they recommended. Neither should those who have maximum scores on the self-care and mobility items at admission, since they have no room for improvement. Gender and Medicaid status should be excluded, but age, history of falls and prior functional status would be appropriate risk-adjustment factors, the panel determined.

Not all self-care and mobility items would be applicable in each post-acute setting, the panelists noted. For example, they discussed dropping the “wash upper body” item for SNFs, because most residents bathe in a tub or shower.

Click here to access the complete CMS document.

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