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Minnesota Efforts to Promote Nursing Home Quality
 

Minnesota Efforts to Promote Nursing Home Quality

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Robert L. Kane, MD

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Robert L. Kane, MD

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    Minnesota Efforts to Promote Nursing Home Quality Minnesota Efforts to Promote Nursing Home Quality Presentation Transcript

    • Minnesota Efforts to Promote Nursing Home Quality Robert L. Kane, MD University of Minnesota School of Public Health NASHP Meeting October 15, 2007
    • Project Team
      • Robert Kane (UM)
      • Greg Arling (UI)
      • Bob Held (DHS)
      • Valerie Cooke (DHS)
      • Christine Mueller (UM)
    • A Variety of Strategies Have Been Tried
      • Pay-for-Performance
      • Quality Bonus
      • NH Report Cards
      • Quality Incentive Payments
    • Pay-for-Performance
      • Payment based on quality score
      • Payment applied to CMI
      • NHs tiered by quality score
      • Average costs per tier
      • NH keeps larger portion or actual costs according to quality
    • Quality Profile Elements
      • Available Now
      • Survey deficiencies
      • Staff/resident ratio
      • Staff retention
      • Use of pool staff
      • Quality indicators
      • % single rooms
      • Quality of Life/Resident Satisfaction
      • Under Development
      • Family Satisfaction
      • Short Stay
      • Community Discharge
      • Environmental Assessment –ability to support independence, dignity and rehabilitation
      • Dementia Care
    • Quality Score
      • On a 100 point scale, maximum points assigned to each quality measure are:
        • Direct Care Hours 10
        • Staff Retention 20
        • Use of Pool Staff 5
        • Quality Indicators from MDS 35
        • Quality of Life/Satisfaction 20
        • Survey Deficiencies 10
    • Relation of Case Mix Component + Support Services Cost PPD and Quality Score
    • Characteristics:
      • Nursing facility specific rates
      • Rates are a function of a pre-determined price, quality and actual costs
      • Acuity-based rates
      • Annually re-based
      • Prospective rate system
      • Phase-in over 4 year period
    • Quality Tiers
      • Ten tiers
      • Ten point increments
      • Tier 1 - lowest quality scores
      • Tier 10 – highest
    • Calculate Target Rates for Operating Components
      • Costs per patient day for each provider are arrayed for each category
      • Lowest populated quality tier target rate is 10th percentile of costs
      • Highest is 90th percentile of costs
      • Adjusted to achieve budget neutrality
    • Quality Incentive Payment
      • Use quality score to adjust difference between target rate and specific facility cost
        • Facilities with costs above or below the target rate receive a portion of the difference, depending on quality score
        • The closer the facility’s costs are to their target rate, the higher percentage of the difference the facility is paid
    • The matrix
    • Who are the Winners
      • Consumers
      • Workers
      • Facilities with high quality
      • Facilities that are efficient
      • Facilities that have better physical plants
      • Facilities that have the ability to adapt to a system that demands quality and efficiency
    • Not passed by legislature
      • Too complicated
      • Some constituents lost money
      • NH opposition
      • No consumer advocacy
    • Quality Add-on
      • NHs paid an additional percentage of payments based on quality scores
      • Year 1: 5 indicators: turnover (15%), retention (25%), pool use (10%), MDH survey (10%) and QIs (40%).
      • Could earn up to 2.4% of their operating rate
        • set up to be an average 1% quality add-on industry wide.
        • Additional 1.3% as COLA.
      • Year 2: quality of life (20%) and direct care hours per day(10%), retention (20%), QIs (35%), pool (5%) and MDH survey (10%)
      • Could earn up to 0.3% as a quality add-on.
        • designed to be .13% on average industry wide. The remaining 1.87% was given as a COLA.
    • NH Report Cards
      • Information for consumers
      • Individualized information
      • Based on available data
    • Components
        • Nursing Hours
        • Staff Turnover
        • Use of Pool Staff
        • Proportion of Single Rooms
        • Quality Indicators from MDS
        • Survey Deficiencies
        • Quality of life
          • From survey of a sample of residents in each NH
    • Report Card Logistics
      • User indicated zip code location and three most important variables
      • received information on NHs order by preferences
      • QOL, citations most valued
    • Performance-Incentive Payment Goals
      • Improve the quality of care and quality of life of nursing home residents in a measurable way.
      • Deliver good quality care more efficiently
      • Rebalance long-term care and make more efficient and effective use of resources.
    • Quality Incentives- Round 1
      • $1.2M state share and with fed match and private pay amounts to about $3.5M in incentive payments
      • 155 applications, 20 projects funded - 1 collaborative of 13 facilities so 32 facilities in total received incentive payments.
      • Most incentives 5% of operating rate
      • Need to show evaluation plan
    • Quality Incentives – Round 2
      • Consortia encouraged
      • Evaluation should fit the QIs in use
      • Intent to study projects to determine the financial impact to the Medicaid budget.
      • $6.7M state share and with fed match and private pay amounts to about $20M in incentive payments
    • MN 2007 NH Rebasing Law
      • NHs will receive cost payments for care related costs up to 120% of group medians
      • 6 groups formed from geography and NH type
      • 8 year phase in with hold harmless
      • Then, care related payments based on limits from 105% to 125% based on quality scores