Due to the COVID-19 pandemic, the Centers for Medicaid and Medicare Services (CMS) announced a temporary freeze to Five-Star Domains in March. CMS made the decision to hold survey data – and freeze measures and ratings across the Five-Star Domain spectrum – to allow nursing homes to focus their full attention on the safety of their residents during the ongoing crisis. However, time itself is not frozen, and nursing homes continue to admit and discharge new patients while these measures remain at a standstill. Patient acuity at the post-acute level varies, and residents are unique in their needs and outcomes – which subsequently changes the dynamics of their respective skilled nursing facilities (SNFs). Though quality measures (QMs) provide a snapshot in time of a SNF’s performance, that performance can change drastically over the course of a year.
Despite CMS’s measures freeze, it’s more important than ever that hospitals and health systems have access to real-time analytics to avoid being left out in the cold.
Measures freeze and its industry impact
In March, a number of waivers were put in place for SNFs – including payroll-based journal (PBJ) waivers, waivers for minimum data set (MDS) QMs, and the suspension of standard surveys – with the intention of ensuring that SNFs remained concentrated on the safety and treatment of their residents. While it may who to include in their preferred provider network based on Medicare Care Compare (previously known as Nursing Home Compare) data, these hospitals will ultimately end up behind the curve and lacking important information. Data from Medicare Care Compare is often skewed toward long-term Medicaid patients rather than short-term Medicare patients – who are actually more prevalent in SNFs – and quality measures are typically lagged anywhere from six months to two years. With survey ratings and some quality measures frozen since March, data quality will only worsen, and hospitals will likely lack critical, up-to-date insights regarding SNF performance if they rely on these sources.
Real-time data and risk-adjusted analytics
To understand current patterns – including outcome trends such as length of stay and rehospitalization rates – providers should invest in tools that are powered by real-time data and are specifically designed to track post-acute utilization and outcomes. CarePort leverages ADT data from its SNF partners to provide hospitals with real-time, risk-adjusted analytics. To give an example of how important this is, let’s look at the CMS quality measure for 30 day rehospitalization. When comparing data from April 2019 to April 2020, the average rehospitalization rate changed 5%, which is an average relative rate change of 27%! This illustrates how drastically these types of measures can change for facilities year over year. If measures information is upwards of a year old, it simply won’t suffice and can result in poor patient outcomes. Access to real-time, risk-adjusted rates for SNF populations provides hospitals with peace of mind that they are making the best, and most informed, choice for optimal patient outcomes.
2020 has been an incredible test of resources and perseverance for SNFs. Though not the first time CMS has suspended measures or adjusted benchmarks, CMS rightly implemented a number of waivers of data submission, in addition to suspending standard surveys, to prioritize COVID-19 infection control and patient safety in SNFs. As the year draws to a close, however, these waivers have either expired or will expire at the beginning of the new year. Once Five-Star Ratings begins updating again, it would be expected for star levels to jump or decline unexpectedly. Following prior data freezes, we have seen extreme examples of this, in which a 5-star SNF was suddenly rated 1-star overall.
Taking all of this into consideration, it will be difficult for hospitals to depend on Medicare Care Compare data as they decide to which post-acute provider they will send their patients. The importance of real-time, risk-adjusted data is more apparent than ever; not only does it provide hospitals with a current and accurate picture of a SNF’s performance, but it also insulates hospitals and health systems from future suspension of public data. Don’t get left out in the cold this winter!
Scott Magnoni is a Senior Research Analyst at CarePort, where he is primarily responsible for molding post-acute outcomes, gathering and analyzing both acute and post-acute data, and creating reports to support client needs.
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