CMS Updates Nursing Home Five-Star Quality Ratings

The Centers for Medicare & Medicaid Services (CMS) have updated their nursing home compare tool to include new quality measures.  The Nursing Home Compare web tool is a resource that provides quality of care and other facility characteristic information to consumers to allow them to compare nursing homes and make informed decisions when choosing a nursing home that meets their needs or the needs of a family member. 

CMS recently added six new quality measures to the website as a part of an initiative to increase the amount of nursing home information available to consumers.  Five of the six new quality measures are currently live.  They are: 

        1. Percentage of short-stay residents who were successfully discharged to the community (Medicare claims- and
            Minimum Data Set (MDS)-based)
        2. Percentage of short-stay residents who have had an outpatient emergency department visit (Medicare claims- 
            and MDS-based)
        3. Percentage of short-stay residents who were rehospitalized after a nursing home admission (Medicare claims- 
            and MDS-based)
        4. Percentage of short-stay residents who made improvements in function (MDS-based)
        5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)

The sixth new quality measure, the antianxiety/hypnotic medication measure, has not yet been incorporated into the system.  The five-star rating system used on the Nursing Home compare website combines ratings in each quality measure catetory to calculate an overall star rating out of five stars for each facility.  The system aims to "give patients and their families important information and helps people compare nursing homes, as well as think of questions to ask when visiting a nursing home. However, the Five-Star Quality Rating system should not be a substitute for visiting a nursing home."

For the time being, the new measures are being implemented gradually and will be fully implemented by January 2017.  Until then, the measures are only counted at half of their new value.  For more information visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-27.html

Supplemental Medical Review Contractor's Plan to Audit All Home Health Health Agencies

The Affordable Care Act (ACA) requires that physicians (and their counterparts) who certify Medicare beneficiaries as eligible for home health services document their face-to-face encounters. In order for payments to be rendered, physicians must prove that these face-to-face encounters actually occurred. In order to validate compliance with this condition, the Office of Inspector General (OIG) conducted a study in 2014 and recently released its findings. The study found limited compliance with Medicare’s Home Health face-to-face requirement.