»» Good morning.
I'm gonna give a quick correction.
I'm Katie Brooks, but Katie Cramer is also fantastic.
(Laughter) How is everybody doing today?
Good.
Welcome to Kansas City.
Thank you so much for taking the time to come out.
We have some very riveting, exciting, fantastic and intriguing topics to go over the next
few days with you.
You know, at any point during the presentations please we would really like to encourage you
to use Slido to enter your questions.
It's a great tool and we take all of the questions that are entered very seriously.
We do our very best to answer every single topic.
Please utilize that tool as much as you guys can to reach out
to us to make sure that you're getting the information that you need.
Thank you again.
Like I said I'm Katie Brooks the IRF QRP Coordinator for CMS.
Again thank you for coming.
We're going to go ahead and get started here.
So as you all know, CMS is riddled with acronyms.
We like to keep things nice and confusing for you.
I know Brigitte mentioned you should all have an acronyms list in your participant folder.
Feel free to use that throughout the day.
To keep things moving.
We're going to be using our acronyms frequently throughout the presentation.
So please keep that list handy, pull it out, set it right in front of you that way you
always have it to refer to when you're going through a specific topic and you're like, hmm,
I don't know what that specific phrase stands for you, can just refer to it easily.
Here's a couple of the acronyms we'll be using in this presentation.
I won't go through them because they're are on the sheet.
A few more acronyms.
So my goals for this presentation is to make sure that all of you understand what the IRF
QRP is, IRF QRP stands for the Inpatient Rehab Facility Quality Reports Program.
I'm going to the summarize high level changes to the IRF-PAI v3.0.
That's coming up to be effective this October.
And that's basically just the new assessment tool that you'll be using to assess all of
your patients.
Finally I'm going to also the a high level overview of the changes to the new IRF-PAI
Manual that accompanies that IRF-PAI v3.0.
So let's start off with our overview of the IRF QRP and make sure everybody understand
why we're here and what the IRF QRP is all about.
The IRF QRP was started by the Affordable Care Act in 2010 which amended the
Social Security Act and required the Secretary
to establish quality reporting requirements for all inpatient rehab facilities.
Starting in the fiscal year 2014.
And every year therefore we required inpatient rehab facilities to submit quality data.
And any facilities not complying with that requirement were subject to a 2-percent penalty
to their Annual Increase Factor also known as an Annual Payment Update.
Additionally in 2014 we had the IMPACT Act which required the submission of standardized
patient assessment data by LTCHs or long-term care hospitals, skilled nursing facilities
or SNFs and then also IRFs and home health agencies.
The Meaningful Measures Initiative was intended to provide a framework for quality measurement
and improvement work 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 takes into account the opportunity to reduce paperwork
and reporting burden on providers associated with quality measurement.
We have begun assessing our quality measures in accordance with the Meaningful Measures Framework if you
need any additional information about the Meaningful Measures Framework.
There's a lot of information provided in the link in the presentation.
You should all have access to that presentation.
This Meaningful Measures Framework involves assessing only those core issues that are
the most critical to providing high quality care and improving individual outcomes.
The meaningful measures area serves as the connectors between CMS goals under development
and individual measure initiatives, that demonstrate how high quality outcomes for our Medicare,
Medicaid and CHIP beneficiaries are being achieved.
They are concrete quality topics which reflect core issues that are most vital to high quality
care and better patient outcomes.
There's examples of the Meaningful measure areas, those include healthcare associated
infections, prevention and treatment of opioid and substance abuse disorders, and each of
these meaningful measure areas help to make connections to specific CMS, such as empower
patients and doctors to make decisions about their healthcare, or support initiative approaches
to improve quality, safety, accessibility and affordability through depicting core issues
that are broader than a given individual measure.
So in summary the Meaningful Measures basically just drives how we determine the measures
that we ask you as IRF providers to report.
Quality data for the IRF-PAI is collected and submitted using three different methods.
We have our IRF-PAI where we take the data that you submit off of assessments that you
collect on our patients, we have our CDC NHSN measures, then finally we have our fee-for-service
claims-based measures.
We have a total of 8 measures from the IRF-PAI.
There are four of them that are listed here.
We have our Falls with Major Injury Measure, our Care Plan ensuring your patient has a
care plan associated.
We have our Functional Outcome Measure which is where we assess a change in self-care for
medical rehab patients as well as a change in mobility score for medical rehabilitation
patients.
We have our discharge self-care score for rehab patients and our discharge mobility
score for rehab patients measure.
Our last two, we have our Drug Regimen Review and our Changes in Skin Integrity.
We'll go very in depth in the Drug Regimen Review and the Section N and the Skin Integrity Review
and the Section M today.
We have three measures that are currently being collected through the CDC NHSN system.
NHSN stands for National Healthcare Safety Network.
It's a fabulous system, very easy to use, very user friendly.
I know that everybody loves the NHSN system.
But I do want to kind of stress the importance of those NHSN measures.
Those are reported separately from the IRF-PAI data and it's very critical that you guys
are going in and reporting those infection rates.
That not only helps with us our quality reporting requirements but does also help the CDC in
kind of keeping track on metrics nationwide.
That NHSN system is very important.
We do have several resources and the CDC also has a great tool to reach out to you if you
have any questions about submitting your data.
I know I joked about it being user friendly, but they are available to help you.
So just keep that in mind.
Our measures there,
we have our CAUTI Measure, we have our Healthcare Influenza Vaccination Measure,
and then we also have our CDI, or our Clostridium difficile Infection measure.
Then we have four claims-based measure, these measures you don't have to the any extra reporting
for.
There's no extra step.
We pull this data off the claims you report to CMS.
We have our Medicare Spending Per Beneficiary Measure.
Our Discharge to Community Measure and then we have two Potentially Preventable Readmission
measures.
Just as an FYI, the data being publicly reported for the -- the Potentially Preventable Readmission
Measures, as of right now you should all be aware that CMS is suppressing the public reporting
of that data until further notice.
For the Potentially Preventable Readmission Measures, the public reporting of that CMS
is currently suppressing the data on Compare.
So you guys log on to IRF Compare.
You'll just see that that data is not being displayed.
And that's being suppressed until further notice.
So you guys have any questions about that, please feel free to use Slido and let me know.
We decided to remove a new measures from the QRP with the fiscal 2019 Rule.
We removed our initial pressure ulcers measure that was replaced with the Changes in Skin
Integrity Measure.
We removed the Patient Influenza Vaccine Measure.
We removed our MRSA Measure and we removed our All-Cause Unplanned Readmission Measure
for 30 days post discharge.
All right.
So just a high level review of again what our goals are for training in the IRF QRP.
We want to really focus on collecting accurate quality data.
So when you guys are going through and you're documenting your IRF-PAI assessments on your
patients, we want you to focus on coding correctly for that patient.
And just know that the data that you code on your IRF-PAI assessments is not just used
for your quality data reporting and your compliance for the IRF QRP but it's used to calculate
the process or the outcome.
It's identified for inclusion and exclusion criteria and also used for risk adjustment
to your outcome measures on admission.
So it's really important that you're accurately collecting data on your patients.
So let's go over a few high -- level changes to the IRF-PAI v3.0.
As a reminder, your IRF-PAI 3.0 goes into effect October 1, 2019, so just a few months
from now.
It's available on our CMS.gov IRF-PAI website.
If any of you don't have the link to that, the links are available in the presentation.
You can access them at any point in time.
So a couple of changes that you're going to notice with our IRF-PAI v3.0.
We deleted the functional modifier, we deleted the FIM instruction and we deleted Section
O, which was Special Treatments, Procedures and Programs.
That also involved deleting the O0250A-O0250C items from the IRF-PAI.
All of this was in response to the fiscal year 2019 Rule.
Again, we took out the functional modifiers.
Here are just a couple of screenshots of those items that we pulled from the IRF-PAI this
year.
This is due to the IRF Prospective Payment System or PPS provision.
The FIM items and functional modifiers are no longer required.
One thing I would like to stress with that, although we say they're no longer required
that does not mean that you need to stop collecting data on them, we just no longer require you
to submit them to CMS.
Again, removal of the FIM instrument from the IRF-PAI v3.0.
We no longer require them.
And then due to the removal of that Patient Influenza Measure we also removed the patient
influenza vaccine items and then again Section O was removed to due to the removal of O0250.
All right.
A couple of updates to the IRF-PAI Manual.
So we received several comments through trainings such as these as well as help desk questions
requesting us to make the IRF-PAI Manual easier for providers to navigate.
And just to use overall some -- -- we heard you, we took that request very seriously.
One the things that we did up front was we reamed it the IRF-PAI Manual just to streamline
things make it very clear that this is the manual that is your guidance, or your guideline
to the IRF-PAI.
So you're going to notice that this year we have a brand new name, IRF-PAI Manual, very
similar manual to what it was previously.
We've renamed it to streamline the name, make it easier to understand what it's for.
We made the manual more user friendly.
It has been significantly updated.
So everything is nice, fresh and clean in there.
I'm not sure if anybody noticed but we did post the IRF-PAI Manual last week so that
is now available to everybody.
That's the manual that applies to IRF-PAI v3.0.
So some of our key structural changes, the IRF QRP and PPS sections were combined.
So previously we had two separate sections.
The structure was long and drawn-out and it wasn't really streamlined or very clear.
We've combined the sections to make everything more user friendly and easier to use.
The overall format is also aligned with other post-acute care quality reporting programs such as
LTCH and SNF.
We have four chapters with IRF-PAI specific coding guidance and five appendices with additional
provider resources.
So a lot of very good information in there, especially for new employees learning how
to use the IRF-PAI for the first time.
The IRF-PAI Manual is perfect reference for them.
We also have an administrative information and a quality indicators section.
Those have been moved to Chapter 2.
IRF-PAI item-by-item coding instructions.
And one thing that I wanted to note is the administrative items refers to items that
are included under identification information, payer information, medical information, discharge
information and therapy information.
I do want to note the change in naming conventions from sections to chapters.
So that is something that is new with the IRF-PAI Manual v3.0.
Our Chapter 1 includes an introduction to the IRF-PAI Training Manual.
Chapter 2 includes item-by-item IRF-PAI coding instructions.
Chapter 3 includes clarification of terminology, something that's always useful when working
with CMS.
Chapter 4 includes CMS data flow/coding and the CMS patient data system.
All right.
We also have the five appendices that we mentioned.
We have impairment group codes and ICD-10-CM codes.
We have an actual copy of the IRF-PAI v3.0.
We have our helpful IRF resources, our CDC submission guidance page, that's for when you're struggling
to submit your NHSN data.
We went ahead and included that submission guidance right in the IRF-PAI Manual for you.
So it's right there, very convenient easy to get to.
And then finally we have our patient privacy and privacy rights under the IRF-PAI PPS.
We have item-by-item coding instructions that have been updated to reflect the removal of
the FIM-associated function modifiers.
We removed the patient influenza vaccination items.
We changed the definition to major surgery, that's item J2000
and that basically just removed general anesthesia as a criteria for major surgery.
That definition has been updated across Post-Acute Care quality reporting programs.
We updated the clarification of terminology to reflect the removal of the FIM items and
we also added new terminology based on frequently asked questions coming into our help desks.
If you have questions I would like to encourage you to enter them into Slido.
I'm about out of time for my presentation.
So I think that Slido is probably the most efficient way to ask questions there.
But again I do want to thank you so much for taking the time to come out to Kansas City
today to participate in our training.
For those of you who are participating online we genuinely appreciate you taking the time
to call into our webinar today.
So thank you so much.
At this point I'm going to pass it over to my colleague Terri.