Nursing Home Quality Initiative Workgroup Meets
(Nov. 19, 2024) On Nov. 13th, the Department of Health (DOH) met with the Nursing Home Quality Initiative (NHQI) Workgroup to review the results of Payment Year 2023 NHQI, which is based primarily on 2022 performance, and to provide an overview of the proposed 2024 NHQI measure set, which will be based on 2023 performance. Other than a few measures that will be calculated based on three rather than four quarters due to federal changes, DOH is proposing to make just one tweak to the NHQI structure. Key information is outlined below.
2023 Results
The Centers for Medicare and Medicaid Services (CMS) approved the 2023 NHQI methodology in May 2024. DOH has completed their calculations and is working on posting preview score sheets on the Health Commerce System (HCS) for providers to review. Members should expect to see those within two weeks.
Based on observations of very low rates at the time that the data was extracted (which coincided closely with a Centers for Disease Control and Prevention (CDC) update of the definition of “up to date”), the new quality measure added for 2023, Percent of Current Healthcare Personnel Up to Date with COVID-19 Vaccines, was eliminated from the 2023 measure set. This reduces the base score from 100 to 95 points. Please note that a similar measure, Percent of Current Residents Up to Date with COVID-19 Vaccines, was not removed.
Measures that showed improvement include measures of pressure ulcer rates, rates of depression, urinary tract infections, as well as the count of J/K/L inspection deficiencies. The rate of falls with injury remained steady at 2.7 percent. Immunization rates for flu and pneumonia declined for both staff and residents, although 97 percent of homes submitted employee flu reports on time. Staffing measures, both overall staffing and use of agency staff, got worse. Note that due to the delays inherent in the NHQI process, the comparisons described here are for Performance Year 2022 compared to 2021.
In addition, 10 measures were eligible for improvement points based on comparisons of this year’s and the prior year’s quintile. For 2023 NHQI, 92 percent of all homes in the NHQI received at least one improvement point, compared to 78 percent in the previous year.
The timeframe of the data used in the 2023 NHQI was as follows:
- Minimum Data Set (MDS) measures are based on Calendar Year (CY) 2022
- Long-stay Resident Flu Vaccination Rates based on October 2021 – June 2022
- Payroll-Based Journal (PBJ) Staffing Data based on CY 2022
- Employee Flu Vaccination Rates based on 2022-23 Flu Season
- Regionally Adjusted Health Inspections as of April 2023
- J/K/L Deficiencies awarded between July 1, 2022 and June 30, 2023
2024 NHQI Methodology (Proposed)
For the 2024 payment year (2023 measurement year), DOH is proposing to maintain the same measures and the same scoring as for 2023. The staff COVID-19 vaccination measure eliminated for Payment Year 2023 would not be used in 2024 either. Those measures that experienced changes to how they are calculated when the MDS assessment instrument was updated in October 2023 would be calculated using data from the first three quarters of 2023. These include:
- Percent of Long Stay High-Risk Residents with Pressure Ulcers
- Percent of Long Stay Low-Risk Residents Who Lose Control of Their Bowel or Bladder
- Percent of Long Stay Residents Whose Need for Help with Daily Activities Has Increased
- Rate of Staffing Hours per Resident per Day
Any member with questions or who is willing to share reactions or suggestions to the 2024 proposal is invited to contact us this week.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841