5 Star Rating System Webinar Final

Best Practice Webinar Series by DartChart, Inc.

Understanding the 5-Star Rating Program for Nursing Home Compare
Using Best Practice Charting to Increase your Facility’s Rating

Presented by: Kevin Miller

Confidential And Proprietary www.dartchart.com

Session Agenda
• Welcome and Program Overview
• Speaker Credentials
• Overview of the 5-Star Rating System
• Charting as a best practice
• How implementing Best Practices can increase your score
• DartChart technology & corporate overview
• Session Q&A

quot;More than three million Americans rely on services provided by a nursing home at
some point during the year,quot; said Kerry Weems, CMS acting administrator. quot;This
should help consumers in narrowing their choices, but nothing should substitute for
visiting a nursing home when making a decision,quot; Weems added.


Speaker Bio
Marilyn Burlenski, R.N., B.S.N.
• President and CEO – Connecticut Alliance for Long Term Care
• Nurse Monitor – State of Connecticut, Department of Public Health
• 25 Years RN experience with a focus on SNF/PPS Consultation/MDS Consultation
• Medical Record Documentation Consulting
• Operations Management Consulting

Session Moderator
Kevin Miller, BS Psychology
• 16 years medical technology and Healthcare software experience
• 5 Years Experience consulting with Hospitals, SNF/LTC and Pharmaceutical MFG with HHS-OIG Healthcare
Compliance Regulations
• BS Psychology, Albright College


Overview of CMS’ Rating System
• Designed by CMS with 3rd-party feedback
from consulting firms and consumers
• Market-driven solution
• Activated in December, 2008
• Consumer-facing web solution
• Overall rating based on 3 metrics for
performance measures
– Health Inspections
– Staffing (RN broken out)
– Quality Measures – based on MDS
• Contains over 200,000 records for health
inspection alone


Why is it important…
• Public scrutiny is at highest level
• Baby Boomers getting ready to retire
• Healthcare technology and electronic
information is changing rapidly
• On the internet – no one can hide
• Creation of a market-driven environment
• Competition +regulation + litigation risk
makes it more difficult to provide care and be
profitable


Customer Facing – Drives competition at the local level


How the rating system works
• Total of 5-stars in rating
• Higher scores correlate to lower rating in each of the three
rating categories
• Weighted scores based on state and national averages
• Health Inspections – Based on state-level inspections
– Deficiencies rated by scope/severity
– Need for Repeats visits to validate correction
• Staffing – based on 2 measures; RN Hours and Total Staffing
hours (RN, LPN and CNA)
– Based on CMS Staff Time Measurement Studies
• Quality Measures – Based on 10 of 19 QM’s posted on Nursing
Home Compare
– Include 7 long-stay and 3 short-stay metrics

Almost one in four (22%) earned the lowest rating of one star. At the other end of the
spectrum, about one in 10 (12%) earned five stars. The remaining 66% of participating
facilities were distributed fairly evenly among the two, three and four star rankings.


Rating Methodology – Health Inspection
• Based on Federal regulations, national
guidance and federally specified survey
process
• Calculated from points assigned to
deficiencies
• Variation exists between States
• 5-Star System based on relative
performance within a state
• Facility performance based on ratings using
the following criteria
• Top 10 % receive 5-star
• Middle 70 % receive 2-3-4 stars
• Bottom 20% receive 1-star rating
• Trying to measure facilities at the state
level
• An artificial bell curve?


Rating Methodology – Health Inspection
• Scoring rules based on health inspection
results and the need for repeat visits
• For health inspection result, points based
on scope and severity
• If scope/severity impact quality measures,
additional points are assigned
• Repeat visits – assigned for 2nd and beyond
based on need for revisit
• Most recent health inspections are
weighted higher than previous inspections


Rating Methodology – Staffing Domain
• Correlation between RN staffing level and
resident outcomes
• Rating for this domain based on 2 measures
• Total nursing hours per resident day
• RN Hours per resident day
• Data Source - CMS form CMS-671 (Long
Term Care Facility Application for Medicare
and Medicaid) entered into OSCAR
• The specific fields that are used in the RN,
LPN, and nurse aide hours calculations are
• RN hours: Includes registered nurses (tag number
F41 on the CMS-671 form), RN director of nursing
(F39), and nurses with administrative duties (F40).
• LPN hours: Includes licensed practical/licensed
vocational nurses (F42)
• Nurse aide hours: Includes certified nurse aides
(F43), aides in training (F44), and medication
aides/technicians (F45)


Scoring Rules– Staffing Domain
• 2 Staffing measures are given equal weight
• RN Staffing and total staffing
• Total staffing score based on the combined
score for each
• To receive a five-star rating, facilities must
meet both RN and total nursing thresholds
from the CMS Staffing Study.


Rating Methodology – QM Domain
• Developed for the MDS-based indicators for
quality of care
• Facility rating based on 10 of 19 of the QM’s
posted in nursing home compare
Long-Stay Residents:
•Percent of residents whose need for help
with daily activities has increased (9.1)
•Percent of residents whose ability to move
in and around their room got worse (9.3)
•Percent of residents who had a catheter
inserted and left in their bladder (5.2)
•Residents with a urinary tract infection (6.1)
•Residents who have moderate to severe pain (8.1)
•Percent of high risk residents with pressure sores (12.1)
•Residents who were physically restrained (11.1)
Post-Acute Care (Short-Stay Residents):
•Short-stay residents with delirium (13.1)
•Short-stay residents who had moderate to severe pain (13.2)
•Short-stay residents with pressure ulcers (13.3)


Scoring Rules– QM Domain
• Long stay measures are included if they are
calculated for +30 assessments
• Short stay measures are included if they are
calculated for at least 20 assessments
Missing Data
• For facilities that have 4 of 7 QM measures,
statewide averages are used for missing QM
measures
• Facilities that receive a QM rating are in one
of three categories:
• They have points for all of the QMs.
• They have points only for the 7 long-stay
QMs (long-stay facilities).
• They have points only for the 3 short-stay
QMs (short-stay facilities)
• No values are imputed for nursing homes
with data on fewer than 4 long-stay QMs
and fewer than 2 short-stay QMs. No QM
rating is generated for these nursing
homes


Overall Rating – Composite Measure
Based on the five-star rating for the health inspection domain, the direct care
staffing domain and the MDS quality measure domain, the overall five-star rating is
assigned in five steps as follows:

Step 1: Start with the health inspection five-star rating.

Step 2: Add one star to the Step 1 result if staffing rating is four or five stars and
greater than the health inspection rating; subtract one star if staffing is one star. The
overall rating cannot be more than five stars or less than one star.

Step 3: Add one star to the Step 2 result if quality measure rating is five stars;
subtract one star if quality measure rating is one star. The overall rating cannot be
more than five stars or less than one star.

Step 4: If the Health Inspection rating is one star, then the Overall Quality rating
cannot be upgraded by more than one star based on the Staffing and Quality
Measure ratings.

Step 5: If the nursing home is a Special Focus Facility (SFF) that has not graduated,
the maximum Overall Quality rating is three stars.


How Charting can impact your rating
Charting Best Practices - Accuracy of data
One of the primary drivers for skewed scores is Copy-Cat charting
• Charting is typically manual documentation on a
monthly flow sheet
• Data copied from one shift to the next or one day to the
next can dramatically impact and skew your CMS data
• Can result in both revenue loss and “bad” data for 5-star
rating scores
• Best Practice – eliminate copy-cat charting by
“masking” the previous shifts entry


Charting Best Practices - Care Plan Compliance
• Derived from MDS items
• Ensuring data is in the system and accurate
• Deficiencies for not adhering to Care Plan
• Ensuring care plan adherence through best practices
– 7-day trend reports
– Manual data entry eliminated
– Managerial intervention
– Direct care compliance report provides verification of form
completion in real time.
– Compliance report provides management oversight of
compliance/accuracy at any given moment.
– Administrative compliance report provides oversight in real time


Charting Best Practices –
Natural Language Charting Cues
• MDS uses verbal cues, not Natural Language
• Can be confusing making it difficult for CNAs to understand
• DC’s WebForms ADL format makes it easier for CNAs to understand ADL
language
• Talk Touch and Take the Weight
– T-T-TW provides language familiar to CNA level staff and readily relates to
ADL assistance level tasks. Much easier language for the staff and helps
translate what they are doing with the residents
– C.N.A understanding translates into accurate data on ADL assistance
levels provided to the resident.


How Charting affects your rating
Charting Best Practices – Data Integrity
• Garbage in = Garbage out
• Direct reflection on MDS
• Impact on Finance and Rating; Facility
viability
• Best practices can halt problems before
they begin


Dart Chart Supports a Best Practice Model
• Designed for Best Practice model
• Automates DNS and Administrative oversight DartChart best practice
• Supports CNA understanding of ADL language users versus CMS metrics
• Trend reports spot problems before MDS
submittal 100%
10%
12% 29%
• Doesn’t allow for copy-cat charting 80%

60% 5 Stars
40% 58% 4 Stars
78%
3 Stars and under
20%
13%
0%
CMS Study 3 DaRT Chart
YRS Users 3 YRS


About DartChart Systems, Inc
• Founded in 1997 – HQ, Milwaukee, WI
• Electronic charting solution for SNF/LTC
• Solution supports the entire MDS charting process
• Reimbursement Optimization technology – directly impacts facility revenue
• Only charting solution that bases its fees on revenue increases – shared
risk/reward pricing model


Questions & Next Steps
• Q&A Session
• Copy of today’s materials
• Summer Education Series – CEU 100%
12%
Programs beginning soon 33%
80% 14%
• Online Demonstration of
DartChart 60% 5 Stars
40% 4 Stars
74% 66% 3 Stars and under
20%
Thank you for joining us!
www.dartchart.com 0%
CMS Study 3 DaRT Chart
YRS Users 3 YRS


5 Star Rating System Webinar Final

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5 Star Rating System Webinar Final