Ask the payment expert ... about quality of care and reimbursements

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Ask the payment expert ... about the observation stay loophole
Ask the payment expert ... about the observation stay loophole

What does good quality of care have to do with payment? 

Many states are at the forefront of pay for performance initiatives. These tie payment incentives to quality measurements and outcomes. These programs are encouraged by the Centers for Medicare & Medicaid Services' value-based purchasing ”Pay for Performance” initiative. 

Two of the programs are the Ohio Long Term Care Quality Initiative and the Minnesota Quality Improvement Incentive Payment (QIIP). 

The Ohio program provides 20 quality incentive measures in key areas of nursing home performance, with person-centered care a guiding principle. Facilities must submit information no later than May 31, 2014, to be considered for the state fiscal year 2015 rate-setting. You can find the information on this quality incentive program in Ohio Senate Bill 264 at http://aging.ohio.gov/ltcquality/inc/docs/129_SB_264_EN_N.pdf. 

The Minnesota QIIP is similar. There are 26 measures in nine domains of practice. Calculations will determine if a facility attained quality improvements from selection time to March 31, 2015. If so, the facility could obtain a $3.50 increase to the daily rate. Each facility could select only one incentive goal that it believed it could achieve. For more information on this program check http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&dID=167796. 

For other state programs and CMS' perspective on nursing home quality improvement programs go to the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/index.html.Advancing Excellence and your state Quality Improvement Organization also are good resources.