DOH 2013-2014 Quality Pool Meeting Update

Nancy Leveille in Clinical & Quality

The Department of Health just notified us today that they anticipate the posting of the 2013 Nursing Home Quality Pool facility-level results to the Health Commerce System (HCS) by tomorrow or Monday at the latest.  They are also working to have these results released publicly so we encourage you to review your data as soon as possible.

The NYS DOH Quality Pool Committee met on Monday November, 4, 2013.  The purpose was to review the results of the 2013 data and discuss proposed criteria for 2014. Key points from the 2013 pool are as follows:

 

  • 2013 utilized 4 quarters of data vs. only 3 quarters used in 2012.
  • The 2013 individual facility reports will be sent out via the HCS system in about 1-2 weeks. DOH is finishing up the reimbursement rate calculations for those SNF’s total scores that fell within the top 3 Quintiles of all facilities.
  • The payment distribution formula will be similar to the 2012 payout methodology.
  • DOH is currently in process of making the comprehensive dataset downloadable through METRIX.
  • There were about 43 SNFs not eligible for consideration of the pool due to being non- Medicaid providers; CMS focused facilities; CCRC Facility; Transitional Care Units; Specialty-only Facility; SNFs with denominators less than 30 on the majority of Quality Measures; and any assessments indicating the residents was on a specialty unit.
  • 26 SNFs were excluded from the pool due to a determination of abuse or fraud by the Attorney General’s office during 2012-2013.
  • DOH will release a press release after the SNFs receive their reports. (NYSHFA requested that the DOH do not highlight SNFs on a list that have had IJs and therefore not eligible for the reward since this information has already been made public and could be from a 2012 survey.  In addition, the Quality Pool criteria already identify this as exclusionary criteria for the Quality Pool.)

 

The 2014 proposed criteria has many of the same elements as 2013. Some issues being discussed are:

 

  • Eliminating the QM for influenza but keeping the compliance reporting element and using both the November and May reports.
  • Increasing the avoidable hospitalization scoring points.
  • Expanding the staffing measure by using a year’s worth of data from the cost report for staff hours/resident day.
  • Staff turnover, resident satisfaction, dental health measures, emergency room visits and other efficiency measures are being discussed for a method of measuring or evaluating care in a consistent method.

 

If members have any questions or input into these, please email or call Nancy Leveille.

NYSHFA CONTACT: Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20