DOH to Recalculate 2013 Quality Pool Results

The Department of Health (DOH) has confirmed with LeadingAge New York that they will be making corrections to the 2013 quality pool scoring and re-issuing the facility-specific reports on the Health Commerce System, possibly by next week. No timetable is currently being given for public release of the quality pool results, which will be delayed beyond next week.

DOH has reviewed the three risk-adjusted Quality Measures (QMs) in the nursing home quality pool (i.e., pressure ulcers, weight loss and pain), and has discovered a programming error that must be corrected.  This could result in positive or negative changes to individual facilities’ scores and point assignments for these QMs.

Nursing homes are excluded from receiving quality pool funding if they had a determination of fraud and abuse by the Attorney General (AG) in 2012-13.  In many cases, the findings were against individual workers in the facility, not the facilities themselves. LeadingAge NY has asked – and DOH has agreed – to confer with the AG’s office to review these exclusions. We have urged that these exclusions be reversed if there were no findings made against the facility itself in these instances.

Finally, we are aware of cases when a facility submitted its cost report by the deadline, but encountered logistical problems in transmitting the operator certification by the due date.  In these instances, the facility would lose not only five compliance points, but also 4.29 points for temporary contract/agency staff usage. We have asked DOH to provide some flexibility on the compliance scoring in these cases, and to use available cost report data to assign a score for temporary contract/agency staff usage.  The Department is reviewing these cases as well.

If your facility is affected by one or more of these issues or others, you should email DOH’s Office of Quality and Patient Safety at NHQP@health.state.ny.us and copy us at LeadingAge NY.  We will keep members posted on the status of these issues. 

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