DOH Proposes Changes to NH Quality Pool

At a meeting of the Nursing Home Quality Initiative (NHQI) Workgroup late last week, the Department of Health (DOH) proposed changes to the methodology for 2015. Among the changes being proposed are revisions to the point distributions, new antipsychotic, staffing hours and staff turnover measures and a change to the Potentially Avoidable Hospitalizations (PAH) measure. Meanwhile, the State has yet to make payment adjustments for the 2013 and 2014 NHQI results.

The new and revised measures are as follows:

1. Replace the current long stay antipsychotic use measure with a measure from the Pharmacy Quality Alliance, which is limited to the Alzheimer’s and dementia population.
2. Replace the CMS 5-star staffing hours measure, which is based on a two-week snapshot, with an annualized staffing hours measure taken from Medicaid cost reports.
3. Institute a new direct nursing employee turnover measure using cost report data.
4. Revise the PAH measure from being based on long stay days to one based on the number of stays contributed by each long stay resident.

Other proposed revisions include: (1) using a quintile method rather than an 85 percent cutoff to assign points for the long stay resident pneumococcal vaccination measure; and (2) changing the method used for small sample size in the quality measures. The overall point distributions in the NHQI would be revised to increase the total points in the quality component from 70 to 75, and correspondingly decrease the weight given to the compliance component from 20 to 15 points. Each of the 15 quality measures (including the new turnover measure) would be worth 5 points, and the points assigned to the five-star quality rating for health inspections would be reduced from 10 to 5 points. 

LeadingAge NY’s Nursing Facility Cabinet will be discussing these proposed changes in detail in an upcoming meeting, and the Association will be submitting comments. Members with comments or questions on the proposed changes should contact us. We did reiterate concerns during the Workgroup meeting on delays in finalizing the methodology each year, and making associated payment adjustments.

DOH received necessary approvals from the federal government authorizing NHQI payments for 2013 and 2014. According to DOH, the schedule of 2013 payment adjustments has been forwarded to eMedNY for processing, and the 2014 adjustments will be sent to the Division of the Budget for review by mid-June.

Facilities are reminded that the 2014 cost report must be completed, filed and certified by Fri., August 14 (for calendar year filers) to be eligible for 5 NHQI points under compliance, and as many as 15 additional points under the existing and proposed quality measures. Each member facility should verify well before the Aug. 14 due date that any individual(s) who would be responsible for certifying the cost report have active Health Commerce System accounts, and have registered to access the electronic certification system.

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