Wednesday, March 23, 2016

A Snapshot of Our Quality Initiative Progress



In May, AHCA broadened its Quality Initiative to further improve the lives of those we care for in skilled nursing care centers across the country. The Initiative challenges member organizations to apply a systematic approach to meet measurable targets in eight areas with a focus on three important priorities: improvements in organizational success, short-stay/post-acute care, and long-term/dementia care. Members who work to achieve these goals now will be better prepared for federal mandates, such as the submission of staffing data in July, upcoming Five-Star changes, the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, and the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program.

Progress

In February, a significant milestone was achieved in one of the eight goals. AHCA announced that its skilled nursing center members had lowered antipsychotic usage by nearly 30 percent nationwide. According to data from the Centers for Medicare & Medicaid Services (CMS), 16.7 percent of residents in member centers were receiving an antipsychotic medication in the third quarter of 2015 compared with 23.6 percent in the fourth quarter of 2011 — a 29.2 percent decrease. This achievement represents a faster rate of reduction and a lower rate of usage than non-member skilled nursing centers, which currently show a 27 percent decrease and 17.4 percent usage rate. At that time, 48.9 percent had achieved the goal of a 30 percent reduction ahead of the target of Dec 2016*.

In addition to safely reducing the use of off-label antipsychotics, members have also made improvements in other priority areas of the 2015-2018 Quality Initiative. Below is a snapshot of that progress:

Organizational Success

  • Goal: Decrease turnover rates among nursing staff (RN, LPN/LVN, CNA/LNA) by 15% or achieve/maintain at or less than 40% by March 2018
  • Progress: As of March 2016*, 5.3% of members have achieved a nursing turnover rate at or below 40%.
  • Note: At this time, progress can only be measured by the number of members who submit their staffing data in LTC Trend Tracker sm, a free, members-only online tool. Members are encouraged to submit their data today. In July, skilled nursing centers will be required to submit their staffing data to CMS, which will eventually provide a national data source for all nursing centers and reported in Five-Star in 2018. Members who submit their data in LTC Trend Tracker sm now will have a better sense of how they are doing compared to their counterparts well ahead of CMS reporting turnover and retention. That information will allow members to set goals to improve. For more information on how to upload turnover and retention data or for frequently asked questions click here and here. Or contact help@ltctrendtracker.com for assistance.


  • Goal: At least 25% of members will measure and report long-stay resident and family satisfaction and/or short-stay satisfaction using the Core-Q survey by March 2018
  • Progress: As of March 2016*, 5.6% of members have achieved this goal.
  • Note: AHCA and NCAL can only measure progress by the number of members who upload their CoreQ results in LTC Trend Tracker sm. The CoreQ — consisting of three questions for long-stay residents/family members and four for short-stay — has been independently tested as a valid and reliable measure of customer satisfaction. Most satisfaction vendors have agreed to add the CoreQ to their questionnaires. Members are encouraged to submit their results today or have their vendor submit on their behalf. To learn more, visit the AHCA or NCAL Quality Initiative websites. For instructions on how to upload results click here or contact help@ltctrendtracker.com for assistance.


  • Goal: Reducing the Number of Unintended Health Care Outcomes by March 2018.
  • Progress: This measure is under development and should be completed by December 2016 at which time a specific target reduction will be set. Members are encouraged to visit the Unintended Health Care Outcomes page here for resources and tools to improve in this area.


Short-Stay/Post-Acute Care

  • Goal: Safely reduce the number of hospital readmissions within 30 days during a skilled nursing center stay by an additional 15% or achieve and maintain a low rate of 10% by March 2018.
  • Progress: As of Q2 2015*, 18.5% of members centers have achieved a 30% reduction in hospital readmissions or achieved a rehospitalization rate below 10%. For more data and resources, click here.
  • Note: Members are encouraged to run their Hospitalization Rate report in LTC Trend Tracker sm to see if they are above or below the national average. This this will give centers a sense of how they are doing in preparation for the addition of this measure to Nursing Home Compare in April and to Five-Star in July. Set a goal to perform at least two-three points better than the average. Contact help@ltctrendtracker.com if you need any assistance. In addition, start counting and tracking the number of patients who are experiencing rehospitalizations by using Advancing Excellence’s free tracking tool.


  • Goal: Improve discharge back to the community by 10% or achieve and maintain a high rate of at least 70% by March 2018.
  • Progress: As of Q1 2015*, 20.7% of AHCA members have improved their baseline rate by 10% or achieved a 70% rate of safe discharges back to the community.
  • Note: Members are encouraged to run their Discharge to Community report in LTC Trend Tracker sm to see if they are above or below the national average. This this will give centers a sense of how they are doing in preparation for the addition of this measure to Nursing Home Compare in April and to Five-Star in July. Set a goal to perform at least two-three points better than the average. Contact help@ltctrendtracker.com if you need any assistance. In addition, start counting and tracking the number of discharges to the community by using Advancing Excellence’s free tracking tool.


  • Goal: 25% of AHCA members will adopt the use of the mobility and self-care sections of the CARE tool and report functional outcome measures using LTC Trend Tracker sm.
  • Progress: This measure requires information from Section GG on the MDS which will be added in October 2016. Thus, data should be available in 2017.


Long-Term/Dementia Care

  • Goal: Safely reduce the off label use of antipsychotics in long-stay nursing center residents by a total of 30% by Dec. 2016.
  • Progress: According to data from CMS as of Q3 2015*, 48.9% of AHCA members have achieved the goal of a 30% reduction. For more data and resources, click here.


  • Goal: Safely reduce hospitalizations among long-stay residents by 15% or achieve/ maintain a low rate of 10% or less by March 2018.
  • Progress: A risk-adjusted MDS based measure developed by PointRight and AHCA will be used. Results will be made available in LTC Trend Tracker sm in 2016. For information and resources, click here.


*The most current data.

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