The Centers for Medicare and Medicaid Services (CMS) is planning to expand the Minimum Data Set (MDS) 3.0 by implementing new or refined MDS coding items, as part of its intention to move towards value-based Medicare payment system.
In the Skilled Nursing Facility (SNF) Proposed Payment System (PPS) rule posted in April 2015, CMS plans to add coding items to Section G of the MDS 3.0 in order to adopt a new cross-setting Quality Measure (QM) for functional status starting in FY 2017 (effective October 2016). CMS proposes to base these new Section G items on the functional items set of the Post-Acute Care Payment Reform Demonstration (CARE). These items would capture the residents’ functional status on the 6-level scale at admission indicating the care plan’s goal, as well as at the resident’s discharge from the facility. At that point the discharge score will be compared to the admission and care plan’s goal scores, to determine outcomes of the care episode. In cases of unplanned discharges, only the admission score and functional goal score will be reported.
In addition, CMS is currently in the process of developing QMs for payment determinations beginning in FY 2018 (effective October 1, 2017), as part of its initiative to add or refine coding questions on MDS 3.0 items in compliance with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT). The IMPACT Act was passed by Congress in September 2014, requiring the alignment of standardized assessments across the care continuum: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs) and Home Health Agencies (HHAs). Among other significant activities, the IMPACT Act calls for the reporting of standardized patient assessment data with regard to quality measures, resource use, and other measures, specifying that the data elements should be standardized and interoperable so as to allow for the exchange of such data among such post-acute care providers and other providers and the use by such providers of such data that has been so exchanged.
These planned FY 2018-related QMs have to do with three quality domains: functional status, skin integrity, and incidence of major falls. Skilled nursing facilities that would not submit quality data to CMS under the IMPACT Act program will have their annual updates reduced by 2 percentage points.
The proposed rule summarizes the planned QMs that will be used for cross-setting measurement in the developing value-based payment system:
- The proposed QM addressing skin integrity and changes in skin integrity is the NQF [National Quality Forum]-endorsed measure, Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678).
- The proposed QM addressing the incidence of major falls is an application of the NQF-endorsed Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (NQF #0674).
- The proposed QM addressing functional status, cognitive function, and changes in function and cognitive function is an application of the Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function (NQF #2631; under NQF review).
LINTECH’s COMET™ provides fully-integrated software solutions with EMR, resident accounts, financial & administrative suites. Our MDS 3.0 Application is being continuously updated with the above, as well as all of the other new rules, in order to make sure that our users arrive at the best outcomes while staying in full compliance.