New Developments in Nursing Home Quality Pool

For the second time in two months, LeadingAge NY was instrumental in driving changes for the benefit of its members in the Nursing Home Quality Pool (now known as the Nursing Home Quality Initiative or NHQI). With the Department's release this week of its recommendations for the 2014 NHQI, LeadingAge NY is working on another round of comments.

The final 2014-15 state budget revised the definition of “fraud and abuse” that had originally resulted in the exclusion of some nursing homes from quality pool distributions.  These facilities were disqualified due to a finding of fraud or abuse against an individual employee.  In each of these situations, there was a finding of individual culpability, but no citations against the facility because the facility both promptly reported the incident and took appropriate measures to protect residents, including immediate termination of the employee.  LeadingAge NY successfully argued that excluding the nursing home from participation in the NHQI was unreasonable, as the violation was due to the actions of an individual employee, and not the facility. As a result, DOH has dropped the fraud and abuse exclusion entirely from the NHQI. 

In addition, within the last week, DOH issued a DAL acknowledging an error in the calculation of the NHQI measure "Percent of Long Stay Residents Experiencing One or More Falls with Major Injury."  The error was discovered by LeadingAge NY ProCare Consultants Kathy Pellatt and Michelle Synakowski during a Quality Metric review for a member facility.  This calculation error was brought to the attention of DOH. When the scores were recalculated, not only was that nursing home moved up, but an additional fourteen nursing homes improved in their quintile ranking, resulting in the opportunity for many of those nursing homes to participate in NHQI funding.

Yesterday, LeadingAge NY participated in a meeting of the NHQI Work Group. DOH detailed its recommendations (please click here) for the 2014 NHQI, which include adding performance improvement criteria for most quality measures; modifying the resident flu and pneumococcal vaccination measures; increasing the weighting of the quality measures; and reducing the weighting of the avoidable hospitalization measure. DOH reported that the Centers for Medicare & Medicaid Services (CMS) should be acting soon on the 2013 NHQI State Plan Amendment and that the proposed changes for 2014 have already been filed with CMS.

LeadingAge NY will be submitting written comments on the proposed 2014 criteria. Members with questions or suggestions on the criteria should contact:

Dan Heim, dheim@leadingageny.org, 518-867-8866