NQF Endorses SNF QM concerning re-hospitalizations along with many others: NQF EMail

From Judy:  This does not mean the measure is implemented.  It means NQF has endorsed the measure and sent it back to CMS who has final say on implementation.  Measure 2510, below is the one for SNFs and can be downloaded by clicking the link.  The following is from an NQF email sent today:

All-Cause Admissions and Readmissions Measure Endorsement 

The National Quality Forum (NQF) has endorsed 17 All-Cause Admissions and Readmissions Measures. Many new measures submitted to this project examined readmissions in post-acute care settings (SNR, IRF, LTCH, Dialysis Facilities, and Home Health). The All-Cause Admissions and Readmissions Standing Committee evaluated these 17 measures, which consisted of 15 new measures and two measures undergoing maintenance review, against NQF's standard measure evaluation criteria.

The Executive Committee unanimously ratified the CSAC's recommendation to endorse admission and readmission measures only with the following conditions:

1. The Admissions/Readmissions Standing Committee will determine which measures must enter the trial period for consideration of Socio-demographic Status (SDS).
2. One-year look-back assessment of unintended consequences. NQF staff will work with Admissions/Readmissions Standing Committee and CMS to determine a plan for assessing potential unintended consequences. The evaluation of unintended consequences will be initiated within approximately one year and possible changes to the measures based on these data will be discussed at that time.

These measures were endorsed with these conditions to ensure that the concerns expressed throughout the consensus process were addressed. To address the lack of consensus in the membership, NQF held a stakeholder webinar with members to discuss the measures under consideration. There were 134 participants on the webinar representing members from all councils. The call provided an opportunity for NQF Members to voice their concerns about overarching issues and specific measures. Based on polling of webinar participants, the highest priority issue related to adjustment of the measures for SDS. There were also concerns regarding the relationship between admission and readmissions rates.

The Admission/Readmission Standing Committee reviewed a total of 18 measures, 15 new measures and three undergoing maintenance review. During the Committee's review of the measures, 15 of the 18 measures were recommended for endorsement. The committee did not reach the 60 percent approval threshold on three measures (Measure # 0327 Risk-Adjusted Average Length of Inpatient Hospital Stay; Measure 2496 Standardized Readmission Ratio (SRR) for dialysis facilities; and Measure # 2512 All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Long-Term Care Hospitals (LTCHs)). Two of the three measures without consensus were approved by the CSAC and the Board. These include readmission measures for dialysis facilities and LTCHs. While concerns regarding attribution were cited for the dialysis measure, the measure was approved to facilitate systems of care to work together to better coordinate care and reduce readmission. For the LTCH readmission measure, concerns focused on the inclusion of readmission to LTCH or acute care hospitals. Additional analyses demonstrated that the number of patients readmitted to LTCHs is relatively low and the strategies to reduce readmissions and improve care coordination should reduce readmissions to either setting.

1. NQF will convene the Admissions/Readmissions Standing Committee to determine which of the recommended measures in this project must enter the trial period for consideration of SDS adjustment.
2. Measure developers and CMS will be required to provide additional analyses outlined by the SDS Expert Panel on the conceptual and empirical relationship between SDS factors and the outcome measured.
3. NQF will work with measure developers and CMS to determine what type of additional analyses would be appropriate for examining potential unintended consequences identified by stakeholders, in particular the relationship between admissions and readmissions.
4. A one-year look-back assessment will examine whether SDS adjustment is appropriate, along with an examination of potential unintended consequences identified by stakeholders.

Measures Endorsed with Conditions:

• Measure 0505: Hospital 30-day all-cause risk-standardized readmission rate (RSRR) following acute myocardial infarction (AMI) hospitalization (ZIP)
• Measure 0695: Hospital 30-Day Risk-Standardized Readmission Rates following Percutaneous Coronary Intervention (PCI) (ZIP)
• Measure 2375: PointRight® Pro 30™ (ZIP)
• Measure 2380: Rehospitalization During the First 30 Days of Home Health (ZIP)
• Measure 2393: Pediatric All-Condition Readmission Measure (ZIP)
• Measure 2414: Pediatric Lower Respiratory Infection Readmission Measure (ZIP)
• Measure 2496: Standardized Readmission Ratio (SRR) for dialysis facilities (ZIP)
• Measure 2502: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities (IRFs) (ZIP)
• Measure 2503: Hospitalizations per 1000 Medicare fee-for-service (FFS) Beneficiaries (ZIP)
• Measure 2504: 30-day Rehospitalizations per 1000 Medicare fee-for-service (FFS) Beneficiaries (ZIP)
• Measure 2505: Emergency Department Use without Hospital Readmission During the First 30 Days of Home Health (ZIP)
• Measure 2510: Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) (ZIP)
• Measure 2512: All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Long-Term Care Hospitals (LTCHs) (ZIP)
• Measure 2513: Hospital 30-Day All-Cause Risk-Standardized Readmission Rate (RSRR) following Vascular Procedures (ZIP)
• Measure 2514: Risk-Adjusted Coronary Artery Bypass Graft (CABG) Readmission Rate (ZIP)
• Measure 2515:Hospital 30-day, all-cause, unplanned, risk-standardized readmission rate (RSRR) following coronary artery bypass graft (CABG) surgery(ZIP)
• Measure 2539: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy (ZIP)

Any party may request reconsideration of the 17 endorsed quality measures by submitting an appeal no later than January 28. To submit an appeal, go to the NQF Measure Database. For an appeal to be considered, the notification must include information clearly demonstrating that the appellant has interests directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests. All appeals are published on the NQF website.

Please contact the project team at readmissions@qualityforum.org with any questions.

Notice for Part B charges in a SNF for the first of the year 2015

This is from the email list serve for CMS MLN Connect Special Edition dated Monday, Dec 29, 2014.  I suspect the MACs will also post and disseminate it.

This applies to (among other things)  Part B therapy in a SNF.  The CPT codes for Part B are from the Physician's Fee Schedule:

Holding of 2015 Date-of-Service Claims for Services Paid Under the 2015 Medicare Physician Fee 

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

MPFS claims for services rendered on or before Wednesday Dec 31, 2014 are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames. 

Page 2-38 diagram incorrect and should not be used, per CMS

From North Carolina Myers & Stauffer newsletter:

Subsequent to the October 1, 2014 CMS release, there was an additional update dated October 9, 2014. However,

the later October 2014 (R) page 2-38; Entry, Discharge, and Reentry Algorithm diagram has been deemed incorrect by CMS and is expected to be corrected in the next revisions slated for 2015. Guidance from the RAI coordinators is to adhere to the prior (October 2014) diagram for accuracy. Please refer any questions to your state RAI coordinator.

Dec 4: Updated info on submitting HIPPS codes on MA Plan Claims: Some Relief on the Admission HIPPS Requirements

We have a new memo from the CMS Medicare Plan Payment Group.  It is posted on my website at:  http://media.wix.com/ugd/255ff5_771cdbdff5614bfab8650429f758dfa7.pdf.

AHIMA: ICD-10 Delay Left Out of Proposed Spending Bill

From AHIMA E-Alert:  Links from AHIMA article likely will not work but more info is at www.AHIMA.org:

PROPOSED SPENDING BILL DOES NOT INCLUDE ICD-10

On Tuesday night, after over two uncertain weeks in which select physician groups, including the Texas branch of the American Medical Association (TMA), pushed lawmakers to include a two-year delay of ICD-10-CM/PCS implementation in a federal spending bill to be passed before the end of this year, the bill was introduced before Congress without language to delay ICD-10. The spending bill must be signed into law by Congress to avoid a government shutdown.

The bill, dubbed a "cromnibus" (part continuing resolution, part omnibus) and officially titled "HR 83 – Consolidated and Further Continuing Appropriations Act, 2015," next has to pass the House of Representatives and the Senate without amendment. The House is slated to consider this legislation later today. AHIMA is encouraging members to continue to advocate for ICD-10 implementation and contact Congress to ensure that amendments are not added to this funding bill.

The Coalition for ICD-10 has cautioned supporters of the October 1, 2015 implementation date to remain vigilant in case language delaying ICD-10 is slipped into the bill as an amendment. In keeping with that message, an #ICD10Matters Twitter Rally yesterday focused on getting the "no delay" message to legislators resulted in approximately 5,000 tweets in one hour.

On Wednesday afternoon, chairman Fred Upton (R-MI) and Chairman Pete Sessions (R-TX), to whom the TMA specifically appealed to add legislation delaying ICD-10 to the current "lame duck" Congress, released this statement on ICD-10 through the Energy & Commerce Committee, chaired by Upton: "As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders." In the 114th Congress, Upton and Sessions will be asking key stakeholders for information about ICD-10 readiness, including both supporters and opponents of the code sets.

Read more at the Journal of AHIMA website.

WHAT DO OPPONENTS HAVE AGAINST ICD-10?

Among some physicians who oppose ICD-10, "misinformation and scare tactics" such as "ICD-10 is too expensive, too difficult to learn, and too complex to implement" may have been "repeated so often people began to believe them," AHIMA official Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director of coding policy and compliance, and public policy & government relations, said this week. A Q&A with Bowman on the website HITECH Answers, outlines the negative impacts that would be associated with any further delay of ICD-10.

Read the Q&A.

New SNF Educational Material Published by CMS

"Skilled Nursing Facility (SNF) Billing Reference<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNFSpellIllnesschrt.pdf>" Fact Sheet (ICN 006846) was revised and is now available in downloadable format. This fact sheet is designed to provide education on Medicare Part A which covers skilled nursing and rehabilitation care in a SNF under certain conditions for a limited time. It includes information for SNF providers about: SNF coverage; SNF payment; and SNF billing.

This covers the benefit period and some unusual billing situations.  


"Skilled Nursing Facility Prospective Payment System<http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243671.html?DLPage=1&DLFilter=skilled&DLSort=0&DLSortDir=ascending>" Fact Sheet (ICN 006821) is designed to provide education on the Skilled Nursing Facility Prospective Payment System (SNF PPS). It includes the following information: background and elements of the SNF PPS.

CDC Long Term Care Toolkit for Influenza Season Free and Available Now

From LeadingAge:

LeadingAge has been collaborating directly with the Centers for Disease Control and Prevention (CDC) in developing resources and disseminating information to members on influenza immunization and the best approaches in combatting the flu virus. 

LeadingAge’s role includes distributing CDC materials as the information becomes available, providing links to relevant webinars and additional staff education resources. 

This flu season, for the 1^st time, the CDC National Vaccine Program Office (NVPO) has developed a toolkit specifically targeted to supporting staff vaccination programs in long-term care.

The toolkit includes resources for increasing influenza vaccination among healthcare personnel in long-term care settings; suggestions for implementing flu vaccine programs at the workplace; and data on flu vaccines and why it's important that employees receive them.

The CDC’s long-term care toolkit is free-of-charge and is now live at: http://www.cdc.gov/flu/toolkit/long-term-care/.