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New Long-Stay Claims-Based Hospitalization Measure to be Posted on Nursing Home Compare October 2018

Centers for Medicare and Medicaid Services (CMS) believes that residents who return to the hospital frequently during their nursing home stay for unplanned reasons are less likely to be receiving proper assessments or care. Attempting to widen those included in hospitalization measures, CMS has created a new measure that is comprised of long-stay residents titled: Number of Hospitalizations Per 1,000 Long-Stay Resident Days.

This brand-new measure is not the measures we are familiar with, for example: Percentage of Short-Stay Residents Who Were Rehospitalized After a Nursing Home Admission used for Nursing Home Compare (NHC) Five-Star Quality Rating System, or Skilled Nursing Facility Readmission Measure (SNFRM) NQF # 2510 used for Value Based Purchasing or Potentially Preventable 30-Day Post-Discharge Readmission Measure used for Skilled Nursing Facility Quality Reporting Program (CMS ID: S004.01).

This new hospitalization measure reports the ratio of unplanned hospitalizations per 1,000 long-stay resident days. Remember this is a claims-based measure which includes those residents on traditional Medicare Fee for Service (FFS). Also, it is a long-stay measure which includes those residents in facility for > 100 days.

Click here for the Nursing Home Compare Claims-Based Quality Measure Technical Specifications July 2018 update. This updated manual has details on the newest hospitalization measure including: purpose, description, numerator, denominator and exclusions. The new measure is slated to be used in the calculation of the Five-Star Rating in Spring, 2019.

Contact: Susan Chenail, schenail@leadingageny.org, 518-867-8846