»» Good morning everyone.
Can you hear me okay?
Good.
As Brigitte said, I am Ariel Adams.
I'm the IRF QRP Coordinator at CMS.
I just have a quick update before I start my presentation about iQIES and I’m just
going to read it to you really quickly.
We would like to remind IRF providers to register for access to the Internet Quality Improvement
and Evaluation System or iQIES.
As a reminder, CMSNet and VPN will no longer be required but all users must create an account
and establish credentials in order to access iQIES.
Please designate at least two IRF providers/security officers per facility that would be responsible
for approving users.
Messages and reminders will continue to be sent to IRFs, but we encourage facilities
to begin this process early and not wait until the last minute when you're ready to submit
your assessments October 1 of this year.
If you are an IRF sub-unit, you must use your facility CCN when requesting user roles.
I will refer you to the QTSO help desk.
And that email is help@QTSO.com.
If you would like to call the help desk, the phone number is 800-339-9313.
Okay everyone.
I'm going to do the Overview of the IRF QRP and Changes to the IRF-PAI Version 3.0.
So this first slide is just acronyms that are going to be within this presentation.
You should have a comprehensive list of acronyms in your presenter's folder.
So this is just another page.
So you can refer to that if you need additional assistance with the acronyms.
So our objectives for this presentation will be to describe the Inpatient Rehabilitation
Facility Quality Reporting Program, summarize the changes to the Inpatient Rehabilitation
Facility Patient Assessment Instrument v3.0, which will be effective October 1 of this
year, and discuss changes to the IRF-PAI Manual that coincide with the IRF-PAI v3.0.
So what is the IRF QRP?
The IRF QRP establishes IRF quality reporting requirements as mandated by Section 3004(B)
of the Patient Protection and Affordable Care Act of 2010.
Section 3004(b) of the ACA amends Section 1886(j)(7) of the Social Security Act requiring
the Secretary to establish quality reporting requirements for IRFs.
Each year, by October 1, CMS publishes the quality measures that IRF providers will be
required to report.
So what if your quality data is not reported?
So IRFs that do not submit quality data are subject to a 2-percentage point reduction
in your annual increase factor.
Additionally, Improving Medicare Post-Acute Care Transformation Act of 2014 requires the
submission of standardized data by long-term care hospitals, skilled nursing facilities,
and home health agencies along with IRFs.
We strongly encourage submitting all of your quality data before the established deadlines.
So if there's any issues, we can, you know, look into those submission issues.
So who can see your data?
So CMS must report this data to the public.
But we do give the opportunity for providers to review this data prior to it being published.
This data is published via our IRF Compare website.
The IRF Compare website began reporting quality data within the late 2016.
So meaningful measures, so our Meaningful Measures Framework is a framework that guides
how we determine what measures we're going to require for reporting.
It really guides measurement and improvement within CMS.
We would like to focus on core issues vital to providing high-quality care and improving
patient outcomes.
Our Meaningful Measure areas serve as a connection between our CMS goals, our measures and our
initiatives.
We'd like to demonstrate high quality care for our beneficiaries.
And some of the examples of our Meaningful Measure areas include our hospital-acquired
infection interventions as well as our prevention and treatment of opioids and substance abuse
disorders.
So quality data for IRF QRP is collected via three ways.
We collect it via the IRF-PAI assessment, our CDC NHSN measures, also our Medicare fee-for-service
claims.
So here we have our IRF-PAI measures.
We have eight measures.
We have the Residents Experiencing One or More Falls with Major Injury.
We have the Long-Term Care Hospital Patients with Admission and Discharge Functional Assessment
and Care Plan.
Also we have our Functional Assessment Measure which is our Self-Care for Medical Rehabilitation
Patients, our Changes in Mobility Score, also our Discharge Self-Care Score, and our Mobility Score of
Medical Rehab Patients.
The last two are the Drug Regimen Reviews which are conducted for follow-up with identified
issues and Changes in Skin Integrity Post-Acute Care Pressure Ulcer and Pressure Injury.
Our CDC Measures include our Catheter-Associated Urinary Tract Infection measures, our Healthcare
Flu Measures, and our C-Diff Measure.
And then our Claims-Based Measures, as you see, our Medicare Spending Per Beneficiary,
our Discharge to Community, Potentially Preventable 30-Day Readmission and Potentially Preventable
Within Stay Readmission.
And these measures are collected when we submit claims.
So they do not require additional submission of data by you.
So our Discharge to Community Measure Update, we’re going to give you that.
So CMS has refined the method by which providers are assigned to performance categories to
align with Potentially Preventable Readmission Measures in the IRF QRP and the Hospital-Wide
Readmission Measure in the Inpatient QRP.
So we revised this methodology result and it resulted in greater variation in performance
categories.
So you will see that this refinement will be reflected Fall of 2019 during the quarterly
refresh of the IRF Compare website.
And you will see it in the June 2019 IRF Provider Preview Reports.
Also, update for the publication of Potentially Preventable Readmission Measures.
CMS postponed publishing this measure until we allowed for more testing.
We have now completed that testing and will publish this measure Fall of this year.
So CMS has refined the method for assigning providers to performance categories which
indicate their level of performance compared to the national rate.
This refinement will be reflected September of this year, the IRF Compare quarterly refresh
in June 2019 in the Provider Preview Reports.
So we're going to briefly go over the measures from the IRF QRP that have been removed.
So we removed or are removing the Percent of Residents with Pressure Injuries or Ulcers
that are New or Worsened.
This measure has been replaced with Changes in the Skin Integrity Measure.
You will continue to see this data until the new measure comes in Fall of 2020.
Also, the removal of the percent of residents who are assessed and given the seasonal flu
vaccine, the last refresh for that measure will be December of 2019.
The removal of the MRSA Measure, data collection ended October 1 of 2018.
And the last refresh will be Fall of 2019.
And the last one, removal of all Unplanned Readmissions for 30 Days Measure, that was
also removed.
So our training is really a focus on collecting accurate data.
This data is used to calculate the assessment-based quality measures to calculate process, or
outcome, identify inclusion and exclusion criteria, as well as apply risk adjustment
to outcome measures.
So therefore, it's just very important to collect accurate data.
So we're going to move on.
And we're going to discuss some of the changes that occurred in our IRF-PAI v3.0.
So again, this version will be available October 1 of this year.
And we have provided several links to the IRF-PAI and supporting documents.
Everyone should be able to access those, those are on our CMS website.
So some of the changes that occurred from v2.0 to v3.0, we deleted functional modifiers,
deleted the FIM instrument, and deleted Section O, O0250A-O0250C.
So this is just a slide demonstrating the removal of that.
We did remove that due to our Prospective Payment System revisions of the FIM.
So we removed, like I said, the FIM and the functional modifiers associated with that.
And this is just a slide reiterating that.
You see for Section O, since we removed the Patient Influenza Quality Measure that this
part of the Section O was also removed.
So changes that we made to the IRF-PAI Manual, so we did take your feedback into consideration
when giving that to us.
So we did try to make it more user-friendly and up-to-date.
We also changed the name to the IRF-PAI Manual so that it’s just more clear what the purpose
of the manual is.
Overall, the format has been changed.
We did combine the IRF QRP and the PPS sections.
We do have four chapters that specifically focus on IRF-PAI coding guidance and five
appendices which actually serve as great resources for providers.
We also added the Administrative Information and Quality Indicators section.
We incorporated it into Chapter 2 which is the Item-by-Item IRF-PAI Coding Instructions.
And we also changed the title of chapters.
Hopefully that's a little more user friendly.
I won't read this to you, I'll just let you guys read this.
But this is available for your information.
And the appendices, these are the titles of the appendices that we have.
So some of the guidance changes.
Of course we removed the information related to the FIM items and associated functional
modifiers.
We removed information for the flu vaccination.
We also changed the definition of major surgery and removed the general anesthesia as criteria
for major surgery.
We did this to make sure that we could align with the other PAC settings.
There was also an update for the "Clarification of Terminology", removal of the FIM items,
and addition of new terminology.
All right.
So if you have any questions for me, please submit those questions via Slido.
And I'm going to turn this over to my colleagues.
Thank you for your time and thank you for being here.
We greatly, greatly appreciate it.
(Applause)