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Nursing Home Quality Workgroup Meets

The Department of Health (DOH) Office of Quality and Patient Safety convened a Nursing Home Quality Initiative (NHQI) Workgroup meeting to review the 2020 payment year (2019 measurement year) results and outline proposed adjustments to the 2021 NHQI. The 2020 payment adjustments are scheduled for release on Dec. 22nd in Medicaid payment cycle 2311.

The 2021 NHQI payment year will be based on measures from 2020, a year that was impacted differently by COVID-19 in various areas of the state and at different times. LeadingAge NY and others have warned that this may result in skewed data. While the structure would remain similar to previous years, four measures would be removed: three suspended due to COVID-19 impact concerns and one eliminated permanently because it has been retired by the Centers for Medicare and Medicaid Services (CMS). The base total score of the remaining measures would be adjusted to ensure that relative weights of each domain remain the same.

The four five-point quality measures that will be removed for the 2020 measurement year/2021 payment year are:

  • Percent of Long Stay High Risk Residents With Pressure Ulcers (suspended for one year)
  • Percent of Long Stay Residents Who have Depressive Symptoms (suspended for one year)
  • Percent of Long Stay Residents Who Lose Too Much Weight (suspended for one year)
  • Percent of Long Stay Residents Who Self-Report Moderate to Severe Pain (retired by CMS)

In addition, the staffing measures that rely on Payroll-Based Journal (PBJ) data would be calculated using only Quarters 2, 3, and 4 of 2020. CMS had made PBJ submissions for Quarter 1 of 2020 optional. Two five-point measures are derived from PBJ data: Staffing Hours per Resident Day and Percent of Contract Staff Used. The 10-point measure of Number of Avoidable Hospitalizations per 10,000 Long Stay Days is derived from the DOH Statewide Planning and Research Cooperative System (SPARCS) data. Completeness and reliability of this data has caused NHQI delays previously. Submission of the 2020 SPARCS data was interrupted by COVID-19 and is currently incomplete. Hospitals have until the end of 2021 to submit the data. The Department will reevaluate the measure in early 2022.

The three measures that were switched from quintile scoring to threshold scoring last year will continue to be scored based on thresholds for measurement year 2020 as well. These include:

  • Percent of Long Stay Residents Experiencing One or More Falls with Major Injury
  • Percent of Long Stay Residents with a Urinary Tract Infection
  • Percent of Long Stay Residents Who Self-Report Moderate to Severe Pain

Two five-point measures suspended last year are back in the mix for the 2020 measurement year:

  • Percent of employees vaccinated for influenza
  • Timely submission of employee influenza immunization data

The slide set from the meeting is available here. Page 8 contains the quintile cut-points for the measures whose scores are calculated using quintiles. Please let us know if you have comments, questions, or concerns regarding the structure of the 2020 NHQI.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 or Ken Allison, kallison@leadingageny.org, 518-867-8820