By the year 2018, Quality Measures will help determine how skilled nursing facilities are compensated based on the quality of services provided. This shift in reimbursement methodology continues a commitment to move Medicare payments from volume to value. CMS has set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they provide to patients.

You may be familiar with the Five-Star Quality Rating System. CMS created it to help consumers, their families and caregivers compare nursing homes more easily. There is one overall five-star rating for each nursing home and a separate rating for each of the following three sources of information:

• Health
• Staffing
• Quality Measures (QMs)

Beginning in July 2016, CMS is adding six new quality measures. All but one of the new measures will be used in the calculation of Five-Star Quality Rating QM ratings. They include:

1. Percentage of short-stay residents who were successfully discharged to the community (Claims-based)
2. Percentage of short-stay residents who have had an outpatient emergency department visit (Claims-based)
3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission (Claims-based)
4. Percentage of short-stay residents who made improvements in function (MDS-based)
5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
6. Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based) (Antianxiety/hypnotic medication measure will not be used in Five-Star due to concerns about its specificity and appropriate thresholds for star ratings.) *Not included in the Five-Star Quality Rating

Our role in providing comprehensive and individualized therapy is more important now than ever for both short and long-term SNF residents. The skilled intervention that we provide will impact not only the Five-Star Quality Rating but eventually the reimbursement that the SNF receives. Keep the above measures in mind and work to collaborate with your multidisciplinary team to:

• Include caregiver education and training during the initial patient encounter for all new therapy admissions to ensure that staff is aware of patient status and therapy’s specific recommendations and instructions
• Develop treatment programs to address conditions that lead to re-hospitalizations i.e. falls, lung congestion, wounds
• Focus on functional performance of ADLs as a part of every therapy session
• Identify residents at risk for decline in ADL function and work to prevent the decline before it happens
• Design and implement comprehensive after-care programs that address ADLs, not just strength and ambulation