I am a Tennessee Volunteer fan through and through. Through all the ups and downs, I love Smokey, our hound dog mascot, wearing Volunteer orange, singing “Rocky Top,” watching the football team run through the gigantic T at home games, and, of course, just being in Neyland Stadium.
For us, “orange bleeders” this year’s Citrus Bowl was euphoric, a real trouncing of the Iowa Hawkeyes, 35 to 0 on Jan. 1. A powerful end to the season. Perhaps a harbinger of things to come in ’24.
As 2024 progresses, you might have noticed that the MDS has taken on new and powerful responsibilities. Recall that the FY 2024 SNF PPS final rule dedicated more than half of its commentary to SNF Quality Reporting Program and the SNF Value Based Purchasing Program.
A focus on equity
Within these programs, CMS has embedded the concept of health equity via a bonus point structure for VBP as well as the addition of social determinants of health data elements for SNF QRP reporting requirements via the revised MDS. CMS has made it clear that for both programs, health equity will be a focus moving forward.
In addition to these initiatives, back in October CMS released a set of health equity confidential feedback reports in IQIES. Two webinar offerings, handouts, and a FACT sheet have been provided with the promise of more guidance to come this month.
You should consider downloading your reports and reviewing them. They contain some interesting provider specific health equity driven data regarding two claims based SNF QRP measures, Medicare Spending per Beneficiary and Discharge to Community.
In these reports, the data related to these two measures have been broken apart so that facilities can see, from a health equity perspective, how they compare to other related groups of residents within their own organization and in subsets of the broader SNF population.
CMS defines health equity as, “… the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of… factors that affect access to care and health outcome,” or social risk factors (SRFs).
Breaking down the data
The SRFs that CMS has chosen to focus on in these reports are the dual eligible and non-dual status, and white and non-white status of residents. Specifically, in the health equity confidential feedback reports, facility data is broken down into eight tables in the following specific ways.
Table 1 — Shows how the average DTC and MSPB Amounts for your patient populations differ from the national average DTC and MSPB Amount for all patients in your care setting.
Table 2 — Provides your patient composition (dual non-dual, white, non-white) and the patient composition (dual non-dual, white, non-white) among facilities in similar geographic locations as you.
Table 3 — Shows the average MSPB Amount and DTC rates for Patients at Your Facility, Compared to All Patients Nationwide.
Table 4 — Compares the average MSPB Amount and DTC rate of each of your patient populations with their national average amount.
Tables 5 and 6 — Show the differences in Average MSPB Amount and DTC rates Within Your Facility for both Dual Status and Race/Ethnicity characteristics.
Table 7 — Provides the average MSPB Amount and DTC rates of your patient populations and the average MSPB Amount and DTC rates for the same populations among patients in similar geographic locations.
Table 8 — Provides the average MSPB Amount and DTC rates of your patient populations and the average MSPB Amount and DTC rates for the same populations among patients at facilities with similar patient composition.
It’s a lot of data that at first glance may seem daunting. However, as a practical matter, these reports have been produced as a resource for providers to begin considering SRFs in their resident populations. CMS has indicated that providers can use the results in these reports to develop strategies that may help reduce the impacts of SRFs for their patients.
With that in mind, one way we can use this data as CMS intends is by harnessing the power of the MDS. Whether you realize it or not, since Oct. 1, 2023, in MDS 3.0 v1.18.11, providers have been collecting Social Determinants of Health, or SRF, data.
The specific MDS items include Race, Ethnicity, Language and Interpreter Services, Social Isolation, Transportation and Health Literacy. I hope you can see the connection between these data elements and the health equity confidential feedback reports.
Putting the MDS to work
Here’s one way we might use/connect this data: As we begin to understand our resident populations from the SRF perspective, i.e. residents who have health literacy or transportation issues, we can examine our internal processes and learn how to ensure their dual status, race or ethnicity are not barriers to engagement and positive outcomes.
Recently, McKnight’s Clinical Daily News ran an article that may help us here. It was titled, “Mobile app bridges racial-based communication gaps among ICU families, docs.”
In this piece, we are introduced to an app called “ICUconnect”. The article reviews research that concluded, “A mobile app targeting intensive care unit (ICU) physicians and family members with loved ones who need palliative care worked well to improve communication issues that exist based on race” and that “ICUconnect was designed to address gaps in communication among Black family members who reported worse communication compared to white family members.”
This is just one example. Not all SRFs are race-based and are more likely to be multifactorial. The takeaway is that the more proficient we as providers become at identifying where gaps like these exist, the better we will be at incorporating quality strategies that may help reduce the impacts that SRFs like these may have on our patients.
The MDS is a powerful tool with powerful data if we use it. Positive outcomes, like increased successful discharge to community and reduced Medicare spending per beneficiary, are achievable. One way we can see those outcomes improve is by embracing these SRF and health equity principles to the end that our residents become the benefited recipients.
I’d like to think that my penchant for orange apparel and Volunteer fandom is a metaphor for the passion we might pursue given the insight that the MDS data and health equity confidential feedback reports offer.
I’m looking forward to the 2024 college football season, if only to see if what we witnessed in the Citrus Bowl is sustainable. “Release the hounds” I say. “Go, Big Orange!”
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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