Last week, our Director of Post-Acute Care Analytics, Tom Martin, took the helm of our thought leadership webinar series, hosting a discussion about the various CMS programs that measure quality in the SNF industry. He laid out the nuts and bolts of three key programs—the Quality Reporting Program, the Value-Based Purchasing Program, and the Five-Star Rating Program—and explained what CMS is trying to accomplish through the quality measures within each. He also shared strategies for interpreting and succeeding under quality measures that are calculated in different ways. Below is a recap of one of the webinar’s main themes—the measurement window. To dive deeper into each of the CMS programs mentioned above, download the full-length recording.
The Importance of the Measurement Window
One of the key takeaways from the webinar is that not all quality measures are created equal. There’s a great deal of variation across these measures and CMS programs. Identifying which measurement window(s)—that is, the period of time the patient is followed—is being used is the key to understanding and interpreting performance data for all of the quality measures. The measurement window also determines which strategy SNFs should use to improve their performance on various quality measures.
- Window #1: Hospital admission through 90 days post-discharge – While there are no SNF quality measures that specifically utilize this window, this period of measurement is critically important to the acute providers who send SNFs patients. When upstream referral partners are being held responsible for patient outcomes 90 days out, they become highly interested in the care offered in post-acute settings. SNFs need to demonstrate that they offer high-quality care in order to be included in narrow networks of preferred post-acute providers.
- Window #2: SNF admission to SNF discharge – Measures calculated using this window, the period of time the patient spends in the SNF, are the most common type of CMS SNF quality measure. CMS has been sharing measures based on this measurement window for over a decade, many of which are used in the Five-Star Program. Ideally, because the patient is 100% under the SNF’s direct care during this measurement window, SNFs should find these measures easiest to improve upon. Unsurprisingly, the Five-Star quality measures that use this window for calculations show significant improvement over the past several years.
- Window #3: 30 days from SNF admission – This window has become more prevalent throughout CMS programs and these measures can now be found in the Value Based Purchasing Program, Quality Reporting Program, and Five-Star Program. For measures with this window, SNFs have slightly less control, as a portion of the period of the time the patient is being followed is likely to occur outside of their facility.
- Window #4: 30 days post SNF discharge – This is the newest measurement window, and measures that use it will be the most difficult for SNF providers to impact because it is based entirely on what happens to patients outside of their four walls. Their ability to influence outcomes is limited; they depend on strong care transitions and care coordination as opposed to internal processes within the SNF.
A Case in Point: Results of the Value-Based Purchasing Program
The VBP Program is a prime example of why measurement windows matter. From Modern Healthcare to McKnight’s to NPR, media outlets across the nation picked up the news that the SNF industry was taking a hit with this program after CMS released performance data in late November. Almost three-quarters of SNFs (73%) were penalized, and as a whole SNFs actually appeared to be performing worse on readmissions. The increased rehospitalization rate was a surprise to many, however, since AHCA’s rehospitalization measurement showed the opposite—that the industry is improving. Why the discrepancy? Because the VBP Program measure (SNFRM), and ACHA measure are using two different measurement windows. The former uses Window #3, which includes time patients spend out in the community, while the latter uses Window #2, which only measures time spent in the SNF.
Strategies for SNF Success
The VBP Program results highlight a finding that is consistent across other CMS programs measuring quality. SNFs have successfully improved the quality of care provided to their patients within their facilities, but they haven’t yet implemented strategies to ensure positive patient outcomes post-discharge. As CMS takes steps to connect the continuum and improve care across the entire patient journey, the ability to track patients post-discharge will become increasingly important.
To learn more about the Quality Reporting Program, the Value-Based Purchasing Program, and the Five-Star Rating Program, and how to manage patients outside of the SNF setting, download the webinar recording.