Among the ~15,000 skilled nursing providers across the U.S., there is tremendous variance in the quality of care provided to patients. While CMS does produce an overall quality ranking for providers on Care Compare with its Five-Star Quality Rating System, its measures are catered toward the custodial patient population, who require assistance with their activities of daily living (ADLs) such as eating and bathing.
The CarePort Quality Score can help health systems focused on placing short-stay skilled patients in SNFs. Skilled care is medically necessary care that can only be provided by or under the supervision of skilled or licensed medical personnel, and could include physical therapy, wound care, intravenous injections, catheter care, and more. The CarePort Quality Score helps ensure health systems leveraging the CarePort platform, the majority of which are participating in a managed or value-based care arrangement, are able to both identify and guide their patients to the SNFs in their market that provide the highest quality of care for their short-stay skilled patient population.
The CarePort Quality Score is optimized for the short-stay patient population in the following ways:
1. After seeking input from experts in the skilled nursing industry regarding the best ways to capture quality for SNF providers, CarePort selected 10 measures to include in its composite rating. The CarePort Quality Score incorporates only those metrics that are relevant to the short-stay population, including the following:
- 30-day rehospitalizations
- Average length of stay (ALOS) for patients discharged to the community
- ADL improvement
- Adjusted registered nurse (RN) hours per resident per day (HPRD)
- Adjusted total HPRD
- Survey citation points
- Emergency department (ED) visits quality measure (QM)
- Discharge to community
- New or worsened pressure ulcers
- Medicare spending per beneficiary
Each of the 10 selected metrics contribute toward a provider’s composite rating, but some metrics are more heavily weighted than others. Measures that have a smaller lag time in their calculation are given a heavier weight, as they more accurately capture current provider performance.
CarePort’s ranking system includes metrics not incorporated within the CMS Five-Star rating like the ALOS metric for patients discharged to the community, whether to home health care, an assisted living facility, or home with no services. This metric helps evaluate the cost and efficiency of SNFs.
2. The CarePort Quality Score is calculated with real-time data, leveraging ADT feeds to reflect up-to-date metrics as part of its ranking system. Other models rely on claims-based data, which is 9 to 12 months old. This issue is only exacerbated by CMS’s ongoing measures freeze; metrics will be more than 2 years old before CMS’s ratings are updated in January 2022.
Real-time data is critical when evaluating SNF quality of care. Over the course of 12 months, the average SNF in the U.S. will experience a change in their 30-day rehospitalization rate of more than 20%. For example, a rehospitalization rate of 20% could jump to 24% or dip to 16% in just one year.
3. Because CMS doesn’t have access to data on Medicare Advantage (MA) patients, its Five-Star Quality Rating System uses Medicare FFS claims data to calculate star ratings. CarePort’s Quality Score, however, is unique in that it incorporates MA patient data.
We anticipate that the majority of patients in SNFs will, in the future, be Medicare Advantage patients, and so the CarePort Quality Score provides a robust picture of SNF quality of care by including that patient cohort within its metrics.
4. The CarePort Quality Score reduces the emphasis on state survey citations as seen in other models. These state surveys are subjective, and dependent upon the surveyor.
5. CarePort’s Quality Score is designed to incentivize SNFs within a market to improve over time. Because the ranking system is calculated on a monthly basis, SNF providers are more consistently held accountable for the quality of care provided, and can show improvement since thresholds are not continuously reset. During CMS’s measures freeze, both hospitals and SNFs have had minimal visibility into up-to-date SNF performance.
For more information on how you can start using the CarePort Quality Score, please contact us.
