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06/30/2016

ODM Releases SNF Quality Payment Rates

ODM Releases SNF Quality Payment Rates

Terry Moore, Chief, Rate Setting Section, Ohio Department of Medicaid (ODM), reported late today that ODM has finalized the July 1, 2016 rates.  As LeadingAge Ohio had noted earlier, ODM had difficulties with the Nursing Home (NH) Compare data for the two (2) MDS-based measures – antipsychotics and pressure ulcers.  Specifically, ODM was struggling with how to handle those providers with blank scores (because of insufficient data) and how to deal with a measurement period in rule (two quarters ending 12/31/15) that differs from CMS’ NH Compare website (three quarters ending 12/31/15). 

LeadingAge Ohio offered ODM some recommendations (with thanks to member/partner, Stephanie DeWees, Squared Business Solutions for assistance on our response).   Ms. Moore shared that after much discussion and analysis, ODM has determined the NF quality measures (antipsychotics and pressure ulcers) as follows:

  1. When a NF provider had a blank score, it was removed from the calculation of the 25th percentile.

  2. All other providers were used to calculate an average score for the two (2) quarters from July 1 through December 31, 2015 as noted in rule.

  3. Based on step 2, ODM identified the NF provider at the 25th percentile.

  4. ODM then added back to providers at the 25th percentile (or below), those providers whose score was blank. 

  5. In summary, providers that had blanks for short and long term stays will be awarded a quality point for pressure ulcers and antipsychotics.  In addition, providers that had a blank or score at or below the 25th percentile will be awarded a quality point for pressure ulcers and antipsychotics.

Effectively, ODM gave providers that had a blank score credit for meeting the long or short term measure.  To be awarded a quality point, providers needed to meet the criteria in step 5.

As a result:

  • 235 NF providers will receive a point for pressure ulcers,
  • 164 NF providers will receive a point for antipsychotics,
  • 684 NF providers will receive a point for staff retention,
  • 903 NF providers will receive a point for PELI, and
  • 907 NF providers will receive a point for the potentially preventable hospital admissions

The remaining 23 NF providers (i.e. CHOPs and new) will receive the average quality payment rate of $0.58 per quality point and an average quality payment rate of $1.85.

Due to these calculations, more providers will be receiving more points than previously projected, however, this has resulted in each quality point being worth less, $0.58 versus $0.82.  ODM has not provided information on when providers will be able to access their facility specific July 1, 2016 final rates.

LeadingAge Ohio will stay close to the release of the information and update our members.  For questions, please contact Nisha Hammel, Director of Advocacy, nhammel@leadingageohio.org or Kathryn Brod, President/CEO, kbrod@leadingageohio.org.

 

 

 

 

 

 

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