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.