The recently published “Quality in Motion: Acting on the CMS National Quality Strategy April 2024” highlights further evolution of the 2022 Centers for Medicare & Medicaid Services (CMS) National Quality Strategy (NQS).

The NQS initially stated plan was aimed at improving the quality and safety of healthcare for everyone, with a special focus on people from underserved and under-resourced communities.

Therapists, as key players on the interdisciplinary team, should take note of the parameters being used to assess overall quality and outcomes and consider their role and value in helping communities achieve stated goals. 

Let’s begin with some definitions. 

What exactly is the “Universal Foundation”?

The “Universal Foundation” further aligns quality measures and will focus on provider attention, reduce burden, identify disparities in care, prioritize the development of interoperable, digital quality measures, allow for cross-comparisons across programs, and help identify measurement gaps. 

Clearly, no small undertaking.

The development and implementation as such have been divided into Preliminary Adult and Pediatric Universal Foundation Measures to promote the best, safest and most equitable care for individuals as we all work together on these critical quality areas

How are measures selected?

  • The measure is of a high national impact
  • The measure can be benchmarked nationally and globally
  • The measure is applicable to multiple populations and settings
  • The measure is appropriate for stratification to identify disparity gaps
  • The measure has scientific acceptability
  • The measure is feasible and computable (or capable of becoming digital)
  • The measure has no unintended consequences

Think back to your statistics class, folks. National reach, stratified, and most importantly, evidence based. 

How is testing of measures completed?

These measures will be used across CMS quality programs and prioritized for stratification and digitization. The CMS Center for Medicare & Medicaid Innovation (CMMI) retains the role to test new and innovative measures.

Ok, so they want to look globally… how do we look at specific measures for each setting?

This will be achieved with add-ons. 

CMS will identify add-on measures to be implemented consistently across applicable programs and will continue developing more add-on sets in 2024, including one for behavioral health. 

Examples of post-acute care-specific add-ons include a focus on behavioral health, person-centered care, safety and seamless care coordination. 

This is where therapy teams can zoom in and consider how their services can be of benefit to their teams. 

Specifically, rehab providers can focus on discharge planning procedures and coordination in care. 

Take, for example, the person-centered care element. The measure used here includes the Discharge Function Score. 

The safety domain includes Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) and Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury. 

Finally, seamless care coordination includes 575: Potentially Preventable 30-Day Post-Discharge Readmission Measure; Discharge to Community-Post Acute Care (PAC); Transfer of Health Information to the Provider Post-Acute Care (PAC); Transfer of Health Information to the Patient Post-Acute Care (PAC).

All of these areas collectively play a role in effective rehab planning, coordination, and discharge effectiveness. 

So, what are the next steps?

  • CMS will develop setting- and population-specific “add-on” measure sets
  • Measures may be replaced or removed when goals are met
  • Measures may be added to assess quality across the care journey
  • CMMI will continue to test new and innovative measures

Want to learn more? 

CMS will solicit feedback on the Universal Foundation through comments, rulemaking, listening sessions and other forums.

To learn more about the impact and next steps of the Universal Foundation, read “Aligning Quality Measures Across CMS -the Universal Foundation” in the New England Journal of Medicine.

Send feedback to [email protected].

Renee Kinder, MS, CCC-SLP, RAC-CT, serves as the Executive Vice President of Clinical Services for Broad River Rehab. Additionally, she contributes her expertise as a member of the American Speech Language Hearing Association’s (ASHA) Healthcare and Economics Committee, the University of Kentucky College of Medicine community faculty, and an advisor to the American Medical Association’s (AMA) Current Procedural Terminology CPT® Editorial Panel, and a member of the AMA Digital Medicine Payment Advisory Group. For further inquiries, she can 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.

Have a column idea? See our submission guidelines here.