IN THIS ISSUE

NY-RAH Project Group B Modifications Beginning in October

New NY-RAH Reports Arriving This Fall 

NY-RAH Facility Advance Directive Completion Achieves New High 

Medicare Inpatient Rule Finalized, Meaningful Use Changes Take Effect 

NFI Around the Nation 

NY-RAH Project Group B Modifications Beginning in October

Effective October 24, 2018, the NY-RAH project will discontinue the role of the Registered Nurse Care Coordinator (RNCC) at each Group B facility and implement a new role of Quality Improvement (QI) Specialist. NY-RAH RNCCs have been providing education, training, and other services at Group B facilities since the inception of the project in 2012. The NY-RAH Project Management Team (PMT) and the Centers for Medicare & Medicaid Services (CMS) believe that reconfiguring the model of the project for Group B will further the goals of Phase Two of the CMS Nursing Facility Initiative (NFI) to maximize billing opportunities for the six qualifying conditions and reduce avoidable hospitalizations.

Under the NFI, both Group A and Group B facilities and their practitioners may avail themselves of the special billing codes created specifically for the Initiative. Group B facilities are also provided with additional supports to further the NFI's goals. There are no program model modifications currently planned for Group A facilities, all of which joined the NY-RAH project in 2016.

Role of the QI Specialist
The QI Specialist will work with Group B facility leadership to review hospital transfers using the claims data that will be accessible through the NY-RAH data portal later this year. The claims data, which NY-RAH obtains through an Information Exchange Agreement between the project and CMS, is the most accurate source of data available for each facility's eligible population. The QI Specialist will review and analyze potentially avoidable hospitalizations as they relate to the six qualifying conditions, and support or conduct QAPI performance improvement projects (PIPs) at each Group B facility.

Transition of Data Collection Responsibilities and Data Report Access
With these changes, Group B facilities will now be responsible for the data collection component of the project -- which all Group A facilities have been responsible for over the past two years. This will entail entering and maintaining a resident roster; providing information on admissions, discharges, and hospital transfers; recording advance directives; and inputting qualifying conditions for which the nursing facility has billed.

Informational Webinar on Year Three Program Modifications
NY-RAH will host a webinar on September 11 to discuss the new model and the role of the QI Specialist.

Please see below for webinar details:

DATE: Tuesday, September 11, 2018
TIME: 1:00 p.m. - 2:00 p.m.
PHONE: (888) 428-7458
WEBINAR LINK: https://join.onstreammedia.com/go/89419339/groupbsept2018

The NY-RAH PMT thanks the RNCCs for all of their hard work over the past six years. Their efforts have allowed the project to focus more on QI and CMS's goals. For any questions about Year Three program modifications, please contact Avril Robinson, NY-RAH Clinical Director.

New NY-RAH Reports Arriving This Fall

In August 2017, the NY-RAH team began receiving Medicare claims and assessment data for all Phase Two eligible residents via a data sharing agreement with CMS. Through this agreement, NY-RAH currently has five years of claims and MDS assessment data for each eligible resident from both Group A and B participating facilities, with the most recent data covering the fourth quarter of 2017. In an effort to provide relevant, actionable reports, the NY-RAH Data Analytics Team is creating new reports for facilities using Tableau, a visualization software program. Tableau gives analysts the capability to build advanced reports that can be easily filtered and sorted, allowing users to drill down from facility-level data to specific resident or episodic information. The reports will highlight topic areas such as potentially avoidable hospital transfers, possible missed opportunities for billing the six qualifying conditions, and practitioner visit patterns. The reports will include bar charts, graphs, maps, and other tables that will present the data in the most accessible way and allow users to identify areas of improvement and perform root cause analyses.

The new reports will be embedded in the NY-RAH data portal beginning this fall and will supplement the existing reports that facilities currently receive on a quarterly basis. The new reports will only be accessible by specific facility staff, and the NY-RAH Data Analytics Team will work with facilities over the next few months to ensure that the appropriate staff have access to the data portal and the new reports. The NY-RAH Data Analytics Team will also provide the necessary training and education on the new reports to ensure that users know how to best use Tableau's functionality and maximize this new data feedback process.

For any questions about the new reports, please contact Courtney Zyla, NY-RAH Data Analyst.

NY-RAH Facility Advance Directive Completion Achieves New High

The NY-RAH team and Group B facilities have recognized the role of advance directives and palliative care in reducing potentially avoidable hospitalizations since the beginning of Phase One. Group B facilities receive a quarterly Palliative Care Report, which highlights the status of advance directive designations on a facility's eligible resident population. Group B facilities have been increasingly successful in engaging their residents and families in conversations about end-of-life care.

In the second quarter of 2018, the percent of eligible residents with an advance directive reached the highest point to date, nearing 100% of the quarter's eligible population. Additionally, the percent of eligible residents with a MOLST form completed has continued to increase, with the second quarter of 2018 as the second consecutive quarter where more than 50% of NY-RAH's eligible residents had a MOLST form completed -- 68% of which were completed in their entirety, the highest percentage achieved for this measure in Phase Two.

The PMT will continue emphasizing advance care planning over the project's next two years as these measure improvements reinforce each facility's willingness to ensure that all residents' end-of-life wishes are discussed and documented.

Medicare Inpatient Rule Finalized, Meaningful Use Changes Take Effect

CMS recently finalized its Federal fiscal year 2019 Acute Inpatient Prospective Payment System (IPPS) rule. In an effort to overhaul the meaningful use (MU) program that is intended to incentivize the adoption of health information technology (HIT), CMS rebranded the program as the Medicare and Medicaid Promoting Interoperability (PI) Programs . CMS originally enacted MU in 2009 under the Health Information Technology for Economic and Clinical Health (HITECH) Act. While eligible hospitals and professionals that met a series of measures that demonstrated MU of electronic health records (EHRs) were qualified to receive incentive payments, the MU program excluded nursing facilities from such payments. Prior MU measures required eligible hospitals to electronically send protected health information to community providers in a structured, secure format known as the C-CDA, an electronic Summary of Care document.

While skilled nursing facilities still do not receive MU incentives, the program's design has the potential to impact nursing facilities' HIT strategies and work with each facility's own EHRs. In addition to the renaming, CMS has also made modifications to MU scoring methodology that:

  • refocuses the program's objective to achieving interoperability (i.e., the ability to exchange data between EHRs)
  • alleviates reporting burdens on eligible hospitals and providers
  • improves patient access to health information

Nursing facilities using MedAllies Mail or other Health Information Service Providers may routinely receive these documents from hospital partners upon admission of a resident. While this will continue in some capacity, CMS has broadened the definition of health information exchange (HIE) to include read-only access to hospital EHRs -- a functionality that some nursing facilities already have. Nursing facilities will also likely experience an increase in the electronic exchange of health information with their hospital partners, with improvements to the processes that support such exchanges. 

If you have any questions about the IPPS final rule, please contact Faiza Haq, NY-RAH Project Manager.

NFI Around the Nation

NY-RAH is one of six projects that received the Phase Two award for the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents -- Payment Reform. Organizations across the NFI speak monthly and meet annually to learn best practices from one another about their projects. NY-RAH highlights one organization each quarter to describe its unique features and best practices.

NYRAH_Spring2017_map

HealthInsight, the quality improvement organization in Nevada, is leading the NFI in the state through its project called the Admissions and Transitions Optimization Program (ATOP). During Phase One, ATOP placed one advanced practice nurse and two registered nurses in five different pods to provide direct clinical care and education on INTERACT throughout 24 participating nursing facilities across the state. ATOP's clinical intervention staff continues to provide the following services for their Group B facilities in Phase Two, which comprises 14 of their original 24 facilities:

  • Discuss residents' conditions with physicians
  • Execute orders
  • Provide education and training for facility staff
  • Assist with end-of-life discussions
  • Perform medication reconciliation
  • Participate in care conferences
  • Assist with coordination of care

Due to the relatively small number of nursing facilities in Nevada (50 in total), ATOP is partnering with 24 Group A nursing facilities in Colorado to participate in the payment reform-only part of the intervention.

For more information on the ATOP ECCP, please visit https://healthinsight.org/atop2.

      NY-RAH is supported by Funding Opportunity Number 1E1CMS331492-01-01 from the US
Department of Health and Human Services, Centers for Medicare & Medicaid Services. The
contents provided are solely the responsibility of the authors and do not necessarily represent
the official views of HHS or any of its agencies.