DOH Finalizes 2018 Quality Pool Scores

The Department of Health (DOH) has finalized 2018 Nursing Home Quality Initiative (NHQI) scores and has posted final score sheets to the Healthcare Finance Data Gateway on the Health Commerce System (HCS). Scores are based on quality performance in 2017. The Dear Administrator Letter (DAL) notifying providers of the posting details the steps for navigating to the appropriate section of the HCS to access score sheets and is available here.

The sheets provide the home’s final score for each measure as well as the home’s overall quintile assignment. Unlike the 5-star methodology, lower quintiles are better, with an overall quintile rank of “FIRST” representing the highest score. Homes with an overall quintile rank of first or second receive a net positive NHQI adjustment, while those in the fourth and fifth quintiles see a net negative adjustment. Homes in the third quintile experience a slightly positive adjustment.

DOH will notify providers when the statewide results, including the quintile cut points for each measure, are posted to the HealthData site. We anticipate payment adjustments to be processed at the same time that the 1 percent supplemental payment is made, likely in the fall. Although the percentages can vary year to year, last year, those in the first quintile had a net positive adjustment representing approximately 1 percent of annual Medicaid revenue, while the adjustment for those in the second quintile was about 0.55 percent. Those in the fourth and fifth quintiles experienced a negative adjustment totaling roughly 0.8 percent of their Medicaid revenue, while those in the third quintile had a nominal positive adjustment equal to roughly 0.1 percent of Medicaid revenue.

LeadingAge NY serves on the NHQI Workgroup that proposes and reviews changes to the NHQI. Highlights from the most recent discussion (November 2018) are available here, and a description of the 2019 methodology, which closely resembles 2018, is available here.

If you have questions, please let us know or reach out to DOH at nhqp@health.ny.gov. We will notify members when the statewide scores are posted.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841