You may be aware that on Feb. 22, Houston-based Intuitive Machines landed a spacecraft on the moon, making history as the first commercial craft to reach the lunar surface and the first U.S. spacecraft on the moon in more than 50 years.
Now that’s something! A moment for celebration, really. However, the celebration was short-lived.
As it turns out, a range-finder glitch, detected just hours before the final descent, forced flight controllers to improvise a work-around to avoid what could have been a catastrophic crash-landing.
As a result, engineers discovered that on landing, one of the lunar lander’s legs got tripped up, and Odysseus had toppled over, substantially limiting communications and battery life, effectively curtailing experiments and cutting the mission short.
Our mission to complete timely, accurate and compliant MDS assessments is also a complicated cavalcade of activity that requires precision and coordination to be successful.
The trifecta of value-based purchasing
Landing timely, accurate and compliant quality reporting data is just one of the outcomes of the RAI process.
Think of it this way: There are four value-based quality reporting programs that, for better or worse, have a significant coordinated impact on a facility’s success publicly, and financially.
Like the lunar lander, these four programs act as “feet” that must be steadfast, or a facility’s quality picture may topple and become ineffective from a public perception, survey scrutiny and financial performance perspective.
Programming highlights
IQIES: The IQIES facility and resident-level quality measure report is a compendium of MDS-based quality measurement statistics.
Its value-based component is twofold. It is designed to help providers focus internal quality improvement efforts, and the data is used by surveyors during facility visits to hone resident samples for further investigation.
These consequences influence the health inspection and quality measure components of the Five-Star Quality Rating System, effectively influencing resident referrals from hospital-preferred provider networks, ACOs and consumer Care Compare consumption.
Five-Star: The Five-Star Quality Rating System Quality Rating website states, “CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.”
It has done that and more. In addition to consumer use, the star rating has become the litmus test for quality. Hospital systems, managed care organizations, the VA and bundled payment initiatives all see the star rating as gospel.
In some locations, unless a facility is 3 stars or better, it’s sayonara to a preferred provider network, managed care or VA contract.
SNF QRP: The Skilled Nursing Facility Quality Reporting Program came on the scene with the passage of the IMPACT Act. This legislation set the groundwork for common quality reporting and standardized patient assessment data elements across the post-acute care spectrum.
Now, wherever a patient is cared for, in a SNF, LTCH, IRF or home health, he or she will be assessed in similar ways within each setting’s unique assessment tool.
One example is the new SNF QRP measure, “Discharge Function Score.” This QM utilizes the shared section GG self-care and mobility items to set a standardized way to compare outcomes across PAC settings. CMS wants to know where it’s getting the best bang for its Medicare buck.
Fiscally noteworthy as well is the fact that the failure of SNFs to report 100% of the MDS data necessary to calculate these QMs on 90% of assessments will result in a 2% reduction to the annual market basket update.
The IMPACT ACT also guarantees that, in the near future, there will be a common payment system for these settings as well.
SNF VBP: The newest kid on the block is the Skilled Nursing Facility Value Based Purchasing program. Brought to life by the Protecting Access to Medicare Act, the SNF VBP will expand from one quality measure to eight by FY 2027.
Currently, CMS withholds 2% from each SNF claim and repays part of that based on a SNF’s rehospitalization rate in a performance year compared to a baseline year.
As the program expands, the bar will continue to be raised related to performance on the eight measures. Spoiler alert: It will be harder to get back the 2% withhold.
In the FY 2024 final rule, CMS added a health equity bonus point structure whereby high performing SNFs can achieve additional points based on the proportion of short stay dual eligible residents it serves.
Let’s compare
It will be important for providers to recognize an emerging connection. Take a look at the table below. Currently, there are nine quality measures that share a connection within these programs.
For example, you may notice that there are three quality measures that are shared among all four, “Changes in Skin Integrity Post-Acute Care: Pressure Ulcer Injury,” “Discharge Function Score” and “Percent of Residents Experiencing One or More Falls With Major Injury.”
A fourth, “Discharge to Community,” shares a connection in the Five-Star, VBP and QRP with “Changes in Skin Integrity Post-Acute Care: Pressure Ulcer Injury,” “Discharge Function Score.” There are other connections you will see as well.
Pulling it all together
The Guardian, reporting on Odysseus’ ill-fated mission, stated, “A multimillion-dollar project, Odysseus was supposed to conduct a suite of experiments … that would have provided data useful for a wave of future missions.”
In the end, it was testing shortcuts and the company’s decision to forgo time-consuming and costly preflight checks to a range-finder system that likely contributed to the mission’s short life span.
When it comes to value-based purchasing programs, SNFs need to be prepared for the future. CMS is not letting up on the throttle. CMS’ triple aim — better care and better health at lower cost — is the driver here.
Paying attention is the key. Providers should take advantage of their IQIES reports, including the facility and resident-specific QM reports, as well as the SNF QRP and VBP confidential feedback reports.
CMS recently released individual facility health equity confidential feedback reports, which can also be found in IQIES.
Beverly Sills, an award-winning operatic soprano, once said, “There are no shortcuts to true excellence. If you take shortcuts, you get cut short. There are no shortcuts in life — only those we imagine.”
No truer words were ever spoken when it comes to the discipline it takes to become an opera star, landing a lunar module on the moon, or successfully navigating the current SNF value-based landscape.
Shortcuts and taking chances are the death of success. SNFs should strive to land all four VBP legs successfully. Odysseus’ outcome is a lesson learned that we can all take to the bank.
Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation. For further inquiries, he may be contacted here.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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