DOH: Nursing Home Transition Access and Quality Work Group Update

Nancy Leveille and Karen Morris in Clinical & Quality


A work group meeting was held on Tuesday, November 5, 2012.  This group is currently working on a proposed measurement set for SNF benefit in Managed Long Term Care and Managed Medicaid Managed Care.  There are three categories (Utilization, Quality and Patient Safety and Transitions of Care) for which development of measures to track performance are being discussed.  DOH was proposing to use the Universal Assessment System for NY (UAS-NY) as their data source.  Below are the early discussion items:

Utilization:  (data taken from the UAS-NY/hospital records for plan members who have had one of these occurrences within the last 90 days.)

  • Prevalence of inpatient acute hospitalizations
  • Prevalence of Emergency Room visits

Quality and Patient Safety:

  • Prevalence of residents who received the Influenza vaccination
  • Prevalence of falls resulting in medical intervention (ER visit for evaluation or admission)

Transitions of Care:  (plan members who have an occurrence within 30 days of an admission)

  • Prevalence of Inpatient Acute Hospitalizations
  • Prevalence of ER Visits
  • Prevalence of falls resulting in medical intervention

NYSHFA questioned the use of the UAS-NY in SNF and recommended the following during the discussion phase of this meeting:

  • MDS data vs. the UAS should be used to obtain the measurement information in SNF.  The Managed Care plan being the payer should have access to the MDS 3.0 for resident assessment information.  The information they are looking at from the UAS is contained in the MDS 3.0.
  • Residents, families and SNF should not have to duplicate any information previously provided and/or currently available.
  • SNF have a high compliance of influenza vaccinations for residents already.  Is this a good measure to use.
  • SNF already have a standard of practice to evaluate each fall in a SNF on a daily basis.  Should we be assessing the prevalence of readmissions for CHF, Pneumonia, Fever, Mental Status changes (the top known DRG related to Hospital readmissions.)

NYSHFA will keep members posted on further developments.

Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15