Good morning everyone.
As Tom said, I'm Lorraine Wickiser.
I'm the coordinator at CMS for The Long-Term Care Hospital Quality Reporting Program.
Throughout this presentation I will be saying LTCH QRP so I won't be extending long winded
names.
It's a lot of acronyms throughout this program.77
I like to see that you guys have a lot of people outside of Baltimore so I'll be throwing
out some little Baltimorean questions or trivia just to see if you guys know.
I didn't know a lot of them and I am from Baltimore.
So I'll kind of break up the training a little bit with that.
To begin with I'm just going to go over some of the changes, deletions or additions that
we have that will be implemented in July 2018 within the quality program for LTCHs.
First I need to advance the slides.
The acronyms within this presentation are on the next couple of slides.
I'm not going to go over them.
But they are there for your referral or reference if you need to look at them.
The objectives hopefully that you get from my presentation is that you'll understand
a little bit of the background of the Quality Reporting Program if you're new to it or haven't
actually looked it up or heard about it.
And also to summarize, the additions, deletions and like I said changes within the LTCH CARE
Data Set implemented this July 1 of 2018.
So my first question about Baltimore, does anybody here know what DMV stands for?
Not many of you.
Not the Department of Motor Vehicle Administration if that's what you were thinking.
In Baltimore it stands for, DC, Maryland and Virginia all around the beltway because people
travel so much around there.
Also.
I want to let you know that you're not really staying at the Lord Baltimore, you're staying
at Bal-more.
If you're in Baltimore you don't say Baltimore with a "T." It's Bal-more hun.
So if you're walking down the street, you can say "will you point me to Lord Bal-more
Hun" and they'll know you're not a tourist and you'll be fine.
(Laughter) So little bit of history of the LTCH QRP is that it started
back in 2010 with the Affordable Care Act that had amended the Social Security Act.
In 2012 we actually started collecting assessment data.
And it wasn't until the implementation of the Improving Medicare Post-Acute Care Transformation
Act of 2014 that we required the LTCHs to submit standardized data and also that they
would be subject to a 2% reduction in their Annual Payment Update.
LTCHs collect their data from three different methods and that would be through the assessment
data, through CDC data, through the National Healthcare Safety Network, and then also through
the Fee-for-Service Medicare Claims.
Before I get into the CMS Meaningful Measures, which is a new initiative within CMS this
year, does anybody know what Jimmy stands for in Baltimore?
Or Bal-more?
Jimmy is the name of the male blue crab.
You know that Maryland is known for their crab.
If you say I want a Jimmy, people will know you want a male blue crab.
I guess if I asked you if you knew what Sally meant you could probably guess what that was.
It's a female blue crab.
Okay.
So the Meaningful Measures is a CMS initiative -- I want to get this right because it's from
CMS directly.
The Meaningful Measures Framework is the Centers for Medicare & Medicaid Services' new initiative
which identifies between highest priorities for quality measurement and improvement.
It involves only assessing those one issues, those core issues that are the most critical
to improving high quality care and improving individual outcomes.
The meaningful measure areas serve as the connectors between CMS goals under development
and individual measures, or initiatives that demonstrate how high quality outcomes for
Medicare, Medicaid and CHIP beneficiaries are being achieved.
They are concrete quality topics which reflect core issues that are most vital to quality
care and better patient outcomes.
Some of the examples would be, prevention and treatment of the opioid substance and
disorders, also the healthcare-associated infections.
Each of these meaningful measure areas help to make the connection to specific CMS goals
such as to empower patients and doctors to make decisions about their healthcare and
support innovative approaches to improve quality, safety, accessibility, and affordability through
depicting core issues that are broader than a given individual measure.
The meaningful measures initiative is intended to provide this framework for quality measurement
and improvement at CMS.
While this framework serves to focus on those core issues that are most vital to providing high quality care
and improving patient outcomes, it also takes into account opportunities to reduce paperwork
and reporting burden on providers associated with quality measurement.
To that end we have begun accessing our quality programs measures in accordance with the Meaningful
Measuring Framework.
You can see on the slide that there's a website you can find more information about the Meaningful
Measures Initiative that CMS has launched this year.
Also if you've done some light reading at night for the rules you'll find that in the
executive portion of those rules.
The next three-pages are just a list of the measures that have been adopted within the
Quality Reporting Program.
I'm not going to go over those.
You can read those and have those.
But they are organized according to assessment, CDC and your claims-based measures.
The training that we're going to go over today just focuses on collecting accurate data.
And CMS really wants to emphasize that we want to
collect accurate data that you're assessing on your patients, not worrying about
what's intended, or dashes that you can put in, or what numbers you can put
in, but to give us accurate real data and real assessment that you're collecting
on your patients.
And then that's also reflected in the public reporting
that's put out there for each of your hospitals or facilities.
We use this data for calculation, for identifying
inclusions and exclusions and for risk adjustment.
It fairs better for you to give us true real assessment data.
The following are webpage links that you can find that will show you
the new LTCH CARE can data set v4.0 that will go live on July 1, 2018.
Also along with that are also the Change Tables.
So changes by section, we have a new Section N which is the Drug Regimen Review section.
All of these sections that I'm mentioning that have changes, we'll go
into more detail throughout the program.
So I'll just give a brief overview and you'll have more detail as the
program and training goes on.
Sections A, B, GG, I, M and O will have either deleted,
additional items, or change of term or language.
The last section obviously you can see is unchanged.
And there will be no changes there.
So the first section is the Administrative section.
We have the program interruption items, three of those that were
removed, A2500, 2510 and 2525.
We are keeping the interrupted stays.
So again if a patient comes within the LTCH, leaves and comes back within those three days
there's not a new admission or discharge.
It is just an interrupted stay.
That does stay the same.
The other administrative change will be the social
security number, and that's the Social Security Number Removal Initiative,
which has already begun.
It started April 1 of this year.
That's really just to decrease the exposure and identity theft within our Medicare beneficiaries.
So that has been replaced.
Again that coding instructions is A0600.
And that's included in all our instructions and our manuals.
Section B: Hearing, Speech, and Vision.
We've added verbal and non-verbal to be a little more inclusive
and clear when you're collecting your data.
So for that section, there's just one change there or
addition, which is your non-verbal.
On to the GG and function data elements, we do
have a new code 10 which we've added to your choices.
And that is Not attempted due to environmental limitations.
We've added that so there would be less dashing.
Also it is applicable to some of the situations when you're assessing function
for some of your patients.
The updated guidance for coding GG0130 and GG0170, we've added 07, 09, 10 and 88.
I'm just mentioning those because they're going to go into greater
detail throughout the training.
I'm not going to spend time going over them, but they are permissible codes within
the GG items.
We have also added a skip pattern for walk 10
feet.
So on admission if you put in those codes, 07, 09, 10, or 88 it will skip
to GG0170Q1.
We also removed some of the gateway questions for walking.
Does the patient walk on the admission and the planned discharge?
This will be covered in detail in the GG section of the training.
Also in GG, we've added -- we clarified some of the language.
So, on 04 we have the definition of Code 04.
With the Supervision and touching we've added "contact-guard".
We've also added a definition for Code 09.
Again you'll see all of that in Section GG.
Quickly for Section I on the Active Diagnoses just a list of all the added items that we
have put in there.
Again to be more declarative in what you can code for your patients, not just all lumped
together.
We can code out exactly which is pertinent for your patient.
For Section I in the metastatic cancer and severe cancer, we've
just broken them out into two separate data set items, as
opposed to just tagging them on.
So again a little more clarity for your patients.
Moving on to Section M with the skin conditions, all the headings,
when we say existing ulcers we're also using "/injuries" so you'll see that
on all the skin conditions when they're listed.
When you ulcers you'll also see injury in that.
And that's applicable, as you can see here to all the M0210, M0300s, all the way through.
We're also removing the term "suspected deep tissue injury
in evolution" and that will be replaced with "deep tissue injury"
language.
And that's in M0300G and M0300G1.
We've also added "device".
So if you're coding injuries with a dressing, it's also "/device" so it covers someone who may
come with a cast or something like that.
Again to be a little more clear and give you some option as to what to put
into the coding if someone were to come in with dressing or devices.
The following items have been deleted and this
is on the Planned and Unplanned Discharge Assessments that's you're M0800
series.
So they have been removed.
The new section is Section N.
We'll have a lot of training on that coming up, that's the Drug Regimen Review, the two
admission data items and one discharge.
So the Drug Regimen Review, the medication follow-up and then the medication
intervention.
We also added the IV medications to Section O
and Special Treatments, Procedures and Programs.
And the measure Spontaneous Breathing Trial by Day 2, and the Ventilator Liberation Rate.
We have removed all the Invasive echanical Ventilator weaning items
with the introduction of the new ventilator measure.
We have kept all the flu measures and the influenza measures.
You can see there's been no change to the O0250A, O0250B, and O0250C.
Again no changes to those following item Sets, C, H, J, K, and Z.
I'm told I need to move quickly.
Changes by section as we had at the beginning of the program, the new section is Section
N for the Drug Regimen Review.
Some of the word changing addition/deletion or addition of the item sets are in sections
listed are A, B, GG, I, M and O. And the unchanged are listed there.
I'm not going to go over the items we added.
We just talked about that and the deleted.
Any questions?
I am going to ask three more quick questions.
Does anybody know what Terp is, stands for in
Maryland?
A Terp, the Terrapins.
The Maryland, football, basketball they're mostly known for, and the lacrosse teams.
It's the mascot for Maryland University.
And how about the O's?
Orioles.
You guys know that.
Okay.
That's it for me.
I'm told I need to get off stage and move on.
But if there's any questions you can submit them.
Unless you have a quick one now, but I think we're going to introduce
the next speaker.
Thank you so much.
I hope you enjoy the training and also your time in Baltimore.