Six months have passed since CMS released its new MDS 3.0 based Quality Measures and the updated 5-Star program. What do these data reveal about your organization, and how can you use this information for quality improvement and risk reduction? Specific analytic insights into CMS’ updated QMs and useful tools will reveal key actions to improve organizational performance while mitigating risk.
Improvement Of Underperforming CMS Star Quality RatingsTimothy Roe
This document provides guidance to sales representatives on improving Medicare Advantage plan star ratings and exploiting opportunities. It outlines 6 areas of focus to enhance based on CMS categories. The areas include screening and prevention of diseases, access to care, care management, drug formularies, member satisfaction, and complaint resolution. Consulting, IT, and business process improvements are mapped to the opportunities. Revenue potential for each area is estimated. Initial due diligence and targeting procedures are described to qualify leads and plans rated 2-3 stars.
This document announces that AHH Rehab received a 4.5 out of 5 star rating from Medicare and was awarded 2016 Small Business Leader of the Year by the Greater Boca Raton Chamber of Commerce. It thanks local physicians for helping the community and provides contact information for AHH Rehab, which offers in-home rehabilitation services founded by Joe Martin and Rosie Inguanzo-Martin.
The Centers for Medicare and Medicaid Services (CMS) made changes to the 5-star rating system for nursing homes. The ratings are based on three measures: onsite inspections, quality measures, and staffing levels. CMS introduced strengthened quality measures to more accurately assess quality and standardize measures for post-acute care. Nearly a third of nursing homes will now receive lower scores under the toughened standards, with only 49% receiving the top two ratings of 4 or 5 stars compared to previously 80%. Changes taking effect in 2015 include factoring the use of anti-psychotic drugs and improved calculations for staffing levels.
The impact of quality and CMS scores on costJames Case
Quality performance is important for provider organizations, but it can be difficult to understand the financial implications of improved quality performance. Despite controversy, the CMS star ratings for providers will have a substantial impact on hospital's financial position through the relationships it has through the entire organization.
Complications of periodontal surgery /certified fixed orthodontic courses by...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Improvement Of Underperforming CMS Star Quality RatingsTimothy Roe
This document provides guidance to sales representatives on improving Medicare Advantage plan star ratings and exploiting opportunities. It outlines 6 areas of focus to enhance based on CMS categories. The areas include screening and prevention of diseases, access to care, care management, drug formularies, member satisfaction, and complaint resolution. Consulting, IT, and business process improvements are mapped to the opportunities. Revenue potential for each area is estimated. Initial due diligence and targeting procedures are described to qualify leads and plans rated 2-3 stars.
This document announces that AHH Rehab received a 4.5 out of 5 star rating from Medicare and was awarded 2016 Small Business Leader of the Year by the Greater Boca Raton Chamber of Commerce. It thanks local physicians for helping the community and provides contact information for AHH Rehab, which offers in-home rehabilitation services founded by Joe Martin and Rosie Inguanzo-Martin.
The Centers for Medicare and Medicaid Services (CMS) made changes to the 5-star rating system for nursing homes. The ratings are based on three measures: onsite inspections, quality measures, and staffing levels. CMS introduced strengthened quality measures to more accurately assess quality and standardize measures for post-acute care. Nearly a third of nursing homes will now receive lower scores under the toughened standards, with only 49% receiving the top two ratings of 4 or 5 stars compared to previously 80%. Changes taking effect in 2015 include factoring the use of anti-psychotic drugs and improved calculations for staffing levels.
The impact of quality and CMS scores on costJames Case
Quality performance is important for provider organizations, but it can be difficult to understand the financial implications of improved quality performance. Despite controversy, the CMS star ratings for providers will have a substantial impact on hospital's financial position through the relationships it has through the entire organization.
Complications of periodontal surgery /certified fixed orthodontic courses by...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
General principles of Periodontal surgeryJignesh Patel
The document discusses general principles of periodontal surgery. It covers patient preparation, indications and contraindications for surgery, local anesthesia techniques, hemostasis methods, periodontal dressings, postoperative pain management, and follow-up evaluations. The goals of periodontal surgery are to gain access for root debridement, establish favorable gingival contours, facilitate plaque control, and potentially regenerate lost periodontal tissues. Proper surgical techniques and postoperative care are essential for healing.
This document provides an overview of risk assessment for periodontal disease. It defines key terms like risk factors, risk indicators, and risk predictors. It discusses several accepted risk elements for periodontal disease like tobacco smoking, diabetes, pathogenic bacteria, tooth deposits, and genetic factors. For each risk element, it provides details on how they increase the risk of periodontal disease based on clinical studies and biological mechanisms. The goal of risk assessment is to help predict a patient's risk and allow early identification and targeted treatment.
The document discusses various periodontal instruments used in dental procedures like probing, scaling, root planing, and surgery. It describes the purpose and usage of different types of probes, scalers, curettes, ultrasonic instruments and other tools. Key details about Gracey curettes, sickle scalers, hoe scalers and techniques like adaptation, angulation and strokes are provided.
This document provides an overview of periodontal instruments, including their classification, parts, materials used, and specific uses. It describes various assessment instruments like mouth mirrors and probes, as well as therapeutic instruments such as scalers, curettes, files, chisels, and surgical tools. The key instruments discussed in detail include mirrors, probes, explorers, sickle scalers, and curettes. It explains the design and uses of each instrument in assessing and treating periodontal disease.
Chronic periodontitis is an inflammatory disease that causes the destruction of the tissues that support the teeth. It is caused by bacterial plaque accumulating at and below the gumline. The disease is characterized by pocket formation, attachment loss, and bone loss. It is usually slowly progressive and can range from mild to severe. Diagnosis involves measuring pocket depths, attachment levels, bleeding, and bone loss visible on radiographs. Risk factors include poor oral hygiene, smoking, diabetes, and genetic factors. Treatment aims to eliminate plaque and bacteria through nonsurgical methods like scaling and root planing or sometimes surgical procedures to reduce pocket depths and regenerate lost tissues.
Quality Control for Quantitative Tests by Prof Aamir Ijaz (Pakistan)Aamir Ijaz Brig
This document provides an overview of quality control and quality assurance processes in a chemical pathology laboratory. It discusses key terms like quality control, quality assurance, internal quality control, external quality assurance. It also describes different types of errors like random error and systematic error. The document explains statistical concepts like measures of central tendency, standard deviation, coefficient of variation. It discusses the Westgard rules for evaluating quality control results and triggering investigations into potential errors. The goal of the lecture is to describe the processes involved in quality management for chemical pathology laboratories.
Our Insights webinar this week tackles a little-known program that will have a big impact on fee-for-service Medicare providers. The Value-Based Payment Modifier (or Value Modifier for short) is something every Medicare provider should know about as soon as possible. One way or another, providers will wind up on either the incentive or penalty side of this legislation. Take advantage of our webinar for in-depth information on this complex and far-reaching topic.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
The document discusses how state veteran's homes can use clinical informatics and predictive modeling software to improve resident care, quality management, and regulatory compliance. It highlights how the software (called EQUIP) analyzes MDS data to identify at-risk residents, target interventions, evaluate outcomes, and benchmark performance against appropriate peer facilities like other state veterans' homes. The software is presented as helping facilities improve quality of care while reducing costs through preventative, evidence-based approaches.
Understanding statistics in laboratory quality controlRandox
This document discusses laboratory quality control and interpreting quality control results. It outlines a 5 step process: 1) Calculate the mean, 2) Calculate the standard deviation, 3) Establish decision limits, 4) Create a Levey-Jennings chart, and 5) Accept or reject results based on quality control rules. Statistics like the mean, standard deviation, and decision limits are used to monitor the accuracy and precision of analytical testing and ensure reliable patient results. Quality control software can automate the calculation of these statistics and generation of charts to more easily monitor performance.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes key points from a CMS 2015 Advance Notice regarding changes that will impact Medicare Advantage plans. It discusses factors that will continue to put downward pressure on plan revenues, such as normalization factors, benchmark trends, and quality rating adjustments. It provides examples of how these changes could impact two hypothetical plans differently, with estimated revenue impacts ranging from a 0.4% increase to over a 10% decrease. The document also examines areas of uncertainty around the new requirements for risk adjustment diagnoses.
The document discusses clinical quality measures (CQMs) and reporting CQMs through Practice Fusion to meet requirements for programs like Meaningful Use and PQRS. It explains that providers are increasingly evaluated on quality and outcomes, describes key quality programs and their CQM reporting requirements, and provides guidance on selecting applicable CQMs and the reporting process through Practice Fusion.
The document discusses the development and implementation of a process to track and measure social work outcomes in a community-based case management program. It provides background on the program and describes existing measures of outcomes related to healthcare utilization, costs, and clinical quality. The authors note that these existing measures do not fully capture social workers' contributions. To address this, they developed a tool to document the unique impacts of social workers across 16 issue categories like housing, nutrition, and education. The tool outlines potential outcomes for each issue and allows tracking of whether outcomes were achieved or reasons for non-achievement.
Maximizing Electronic Health Record Use in Physician Practices to Minimize RiskSedgwick
This document discusses maximizing the use of electronic health records (EHRs) in physician practices while minimizing risks. It provides an overview of the meaningful use incentive program and its stages of implementation. It identifies potential liability issues with transitioning to EHRs, such as communication barriers and alert fatigue. The document recommends strategies for practices to prepare for EHR implementation, including using "dummy" patients and reviewing physician experience. It stresses the importance of organizing EHR assessments, applying basic risk management principles, and developing methods to evaluate policies, charts and interviews.
CMS is proposing several changes to the Quality Payment Program (QPP) for calendar year 2024, including:
1. Removing 3 quality measures from the Traditional MIPS program and adding a new composite measure and 13 other measures.
2. Modifying the automatic reweighting criteria for certain clinician types in the Promoting Interoperability category.
3. Adding 5 new measures to the Cost category and removing 1 measure.
4. Adding 5 new Improvement Activity measures and modifying or removing others.
5. Increasing the MIPS performance threshold and modifying how procedure data is publicly reported.
6. Proposing changes to the MVP framework including consolidating 2 MVPs and modifying existing MVP
Measuring & Monitoring Clinical Quality Measures Using Practice FusionPractice Fusion
Review CMS quality measures, how to capture the data in Practice Fusion, and how this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
General principles of Periodontal surgeryJignesh Patel
The document discusses general principles of periodontal surgery. It covers patient preparation, indications and contraindications for surgery, local anesthesia techniques, hemostasis methods, periodontal dressings, postoperative pain management, and follow-up evaluations. The goals of periodontal surgery are to gain access for root debridement, establish favorable gingival contours, facilitate plaque control, and potentially regenerate lost periodontal tissues. Proper surgical techniques and postoperative care are essential for healing.
This document provides an overview of risk assessment for periodontal disease. It defines key terms like risk factors, risk indicators, and risk predictors. It discusses several accepted risk elements for periodontal disease like tobacco smoking, diabetes, pathogenic bacteria, tooth deposits, and genetic factors. For each risk element, it provides details on how they increase the risk of periodontal disease based on clinical studies and biological mechanisms. The goal of risk assessment is to help predict a patient's risk and allow early identification and targeted treatment.
The document discusses various periodontal instruments used in dental procedures like probing, scaling, root planing, and surgery. It describes the purpose and usage of different types of probes, scalers, curettes, ultrasonic instruments and other tools. Key details about Gracey curettes, sickle scalers, hoe scalers and techniques like adaptation, angulation and strokes are provided.
This document provides an overview of periodontal instruments, including their classification, parts, materials used, and specific uses. It describes various assessment instruments like mouth mirrors and probes, as well as therapeutic instruments such as scalers, curettes, files, chisels, and surgical tools. The key instruments discussed in detail include mirrors, probes, explorers, sickle scalers, and curettes. It explains the design and uses of each instrument in assessing and treating periodontal disease.
Chronic periodontitis is an inflammatory disease that causes the destruction of the tissues that support the teeth. It is caused by bacterial plaque accumulating at and below the gumline. The disease is characterized by pocket formation, attachment loss, and bone loss. It is usually slowly progressive and can range from mild to severe. Diagnosis involves measuring pocket depths, attachment levels, bleeding, and bone loss visible on radiographs. Risk factors include poor oral hygiene, smoking, diabetes, and genetic factors. Treatment aims to eliminate plaque and bacteria through nonsurgical methods like scaling and root planing or sometimes surgical procedures to reduce pocket depths and regenerate lost tissues.
Quality Control for Quantitative Tests by Prof Aamir Ijaz (Pakistan)Aamir Ijaz Brig
This document provides an overview of quality control and quality assurance processes in a chemical pathology laboratory. It discusses key terms like quality control, quality assurance, internal quality control, external quality assurance. It also describes different types of errors like random error and systematic error. The document explains statistical concepts like measures of central tendency, standard deviation, coefficient of variation. It discusses the Westgard rules for evaluating quality control results and triggering investigations into potential errors. The goal of the lecture is to describe the processes involved in quality management for chemical pathology laboratories.
Our Insights webinar this week tackles a little-known program that will have a big impact on fee-for-service Medicare providers. The Value-Based Payment Modifier (or Value Modifier for short) is something every Medicare provider should know about as soon as possible. One way or another, providers will wind up on either the incentive or penalty side of this legislation. Take advantage of our webinar for in-depth information on this complex and far-reaching topic.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
The document discusses how state veteran's homes can use clinical informatics and predictive modeling software to improve resident care, quality management, and regulatory compliance. It highlights how the software (called EQUIP) analyzes MDS data to identify at-risk residents, target interventions, evaluate outcomes, and benchmark performance against appropriate peer facilities like other state veterans' homes. The software is presented as helping facilities improve quality of care while reducing costs through preventative, evidence-based approaches.
Understanding statistics in laboratory quality controlRandox
This document discusses laboratory quality control and interpreting quality control results. It outlines a 5 step process: 1) Calculate the mean, 2) Calculate the standard deviation, 3) Establish decision limits, 4) Create a Levey-Jennings chart, and 5) Accept or reject results based on quality control rules. Statistics like the mean, standard deviation, and decision limits are used to monitor the accuracy and precision of analytical testing and ensure reliable patient results. Quality control software can automate the calculation of these statistics and generation of charts to more easily monitor performance.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes key points from a CMS 2015 Advance Notice regarding changes that will impact Medicare Advantage plans. It discusses factors that will continue to put downward pressure on plan revenues, such as normalization factors, benchmark trends, and quality rating adjustments. It provides examples of how these changes could impact two hypothetical plans differently, with estimated revenue impacts ranging from a 0.4% increase to over a 10% decrease. The document also examines areas of uncertainty around the new requirements for risk adjustment diagnoses.
The document discusses clinical quality measures (CQMs) and reporting CQMs through Practice Fusion to meet requirements for programs like Meaningful Use and PQRS. It explains that providers are increasingly evaluated on quality and outcomes, describes key quality programs and their CQM reporting requirements, and provides guidance on selecting applicable CQMs and the reporting process through Practice Fusion.
The document discusses the development and implementation of a process to track and measure social work outcomes in a community-based case management program. It provides background on the program and describes existing measures of outcomes related to healthcare utilization, costs, and clinical quality. The authors note that these existing measures do not fully capture social workers' contributions. To address this, they developed a tool to document the unique impacts of social workers across 16 issue categories like housing, nutrition, and education. The tool outlines potential outcomes for each issue and allows tracking of whether outcomes were achieved or reasons for non-achievement.
Maximizing Electronic Health Record Use in Physician Practices to Minimize RiskSedgwick
This document discusses maximizing the use of electronic health records (EHRs) in physician practices while minimizing risks. It provides an overview of the meaningful use incentive program and its stages of implementation. It identifies potential liability issues with transitioning to EHRs, such as communication barriers and alert fatigue. The document recommends strategies for practices to prepare for EHR implementation, including using "dummy" patients and reviewing physician experience. It stresses the importance of organizing EHR assessments, applying basic risk management principles, and developing methods to evaluate policies, charts and interviews.
CMS is proposing several changes to the Quality Payment Program (QPP) for calendar year 2024, including:
1. Removing 3 quality measures from the Traditional MIPS program and adding a new composite measure and 13 other measures.
2. Modifying the automatic reweighting criteria for certain clinician types in the Promoting Interoperability category.
3. Adding 5 new measures to the Cost category and removing 1 measure.
4. Adding 5 new Improvement Activity measures and modifying or removing others.
5. Increasing the MIPS performance threshold and modifying how procedure data is publicly reported.
6. Proposing changes to the MVP framework including consolidating 2 MVPs and modifying existing MVP
Measuring & Monitoring Clinical Quality Measures Using Practice FusionPractice Fusion
Review CMS quality measures, how to capture the data in Practice Fusion, and how this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
Comparison of RECIST 1.0 and 1.1 - Impact on Data ManagementKevin Shea
A review of the two RECIST versions, noting similarities and differences, highlighting the improvements in v.1.1. This information is used to discuss how some of the challenges RECIST presents to data management can be addressed.
This document discusses quality control, quality assurance, and quality assessment in medical laboratories. It defines key terms like quality control, quality assurance, and quality assessment. Quality control refers to analytical measurements used to assess data quality, while quality assurance is an overall management plan to ensure data integrity. Quality assessment determines the quality of results generated by evaluating internal and external quality programs. The document outlines quality assurance and quality control processes like standard operating procedures, equipment and reagent validation, personnel competency, and documentation. It also discusses error types, control chart interpretation, and Westgard rules for evaluating quality control results.
The document discusses quality control, quality assurance, and quality assessment in medical laboratories. It defines key terms like quality control, quality assurance, and quality assessment. Quality control refers to internal processes like controls to ensure tests are working properly. Quality assurance refers to the overall program to ensure correct results are reported. Quality assessment involves external challenges to evaluate the laboratory's programs. The document outlines quality assurance cycles and compares quality control and quality assurance. It also discusses corrective actions and root cause analysis for external quality assessment troubleshooting.
9 Quality Management System_EAT G H 2021.pptxNagaraju94925
The facility conducts various quality assurance activities including internal assessments, medical audits, death audits, and prescription audits on a periodic basis. Key processes are mapped to identify non-value adding activities and areas for improvement. Feedback from patients and employees is collected through satisfaction surveys and analyzed, with action plans developed to address low scoring areas. Quality management is supported by documentation like a quality manual, standard operating procedures, and maintenance of documents and records. Continuous improvement is pursued through the plan-do-check-act cycle based on results of assessments, audits and analyzing inputs from stakeholders.
Similar to Analytic Insights from CMS's Five-Star and New Quality Measures (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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3. Introduction
• The nursing home Quality Measures (QMs) come from
MDS resident assessment data routinely collected at
specified intervals
– Posted on Nursing Home Compare
– A subset of measures are used for the Five-Star calculation
• Quality Measures on the Nursing Home Compare
website allow consumers, providers, states and
researchers to compare information on nursing homes.
• Many nursing homes use this information to guide
quality improvement efforts and monitor progress
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4. Changes in the MDS 3.0 Quality
Measures
• Although there are many similarities between
the MDS 2.0 and 3.0 QMs, the differences may
affect your facility’s trigger rates
– Resident Selection
– Record Selection
– Resident Assessment Method
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5. Resident Selection
MDS 2.0 MDS 3.0
Post-Acute Care (PAC): PPS 5-day and 14- Short Stay (SS): </=100 cumulative days in
day MDS facility
Chronic Care (CC): OBRA Quarterly, Long-Stay (LS): =/>101 cumulative days in
Annual, Significant Change, Significant facility
Correction
Changes in the resident sample selection affect the denominator size
for Short Stay and Long Stay measures
• Short Stay sample may be larger than PAC due to 100 day time
period
• Long Stay residents remain in LS sample even after reentry from
hospital
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6. Residents on Leave of Absence
• Residents who leave for a temporary home
visit/therapeutic leave
• Residents who have a hospital observation
stay <24 hours and are not admitted
– Discharge assessment is not completed
– These residents can trigger for incidents outside
the facility (e.g. fall w/fracture)
• LOA days still count towards resident’s
Cumulative Days in Facility
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7. Record Selection
• Selection of MDSs used in the QM calculation
no longer based solely on MDS reason for
assessment (RFA)
• Resident’s span of time in the facility dictates
which measures may trigger
– An OBRA assessment may trigger a Short Stay
measure if the resident has </=100 CDIF
– A PPS assessment may trigger a Long Stay
measure if =/> 101 CDIF
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8. Record Selection (cont.)
• Look-Back Scan: used to capture triggering
conditions within the episode
– May not be the most recent MDS
• Three measures with look-back scans
– New/Worsening Pressure Ulcers (SS)
• Looks back up to the beginning of the episode
– Falls (LS)
– Falls with Major Injury (LS)
• Look back up to a year (275 + 93 days)
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9. Resident Assessment Method
• Resident interview only for Pain assessment
– Residents who were not interviewed excluded
from SS and LS measures
– Reduces denominator size
• New/Worsening Pressure Ulcers
– Stage 2-4 only
– Section M0800 not completed on first assessment
since most recent entry/reentry
• Excludes hospital acquired/worsened ulcers
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11. New Antipsychotic Measures
• Different from the antipsychotic “surveyor
measure” on CASPER
– Fewer exclusions
• Incidence of Psychoactive Medication Use (SS)
– Short-stay residents who did not receive antipsychotic
on initial assessment and do receive it on target
assessment
• Prevalence of Psychoactive Medication Use (LS)
– Long-stay residents who receive antipsychotic
• Both measures only exclude residents with
Schizophrenia, Tourette’s or Huntington’s
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12. Average QM Rates 2.0-3.0
• The differences in data collection and record
selection have resulted in different QM rates
for measures that had “similar” MDS 2.0
counterparts
• Even though the actual QMs can’t be
compared from MDS 2.0 to MDS 3.0, how the
public sees your facility’s rates doesn’t change
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17. “The primary goal of this rating system is to
provide residents and their families with an
easy way to understand assessment of
nursing home quality, making meaningful
distinctions between high and low performing
nursing homes.”
CMS’s Five-Star Technical Users’ Guide
July 2012
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18. CMS’ Five-Star Program
• The rating system features an overall
Five-Star rating based on facility performance
for three types of performance measures:
– Health Inspection (CASPER)
– Staffing (CASPER)
– Quality (Public Quality Measures)
• The rating system has been available to the
public on Nursing Home Compare since
December 18, 2008
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19. Quality Measures Domain
• Facility ratings for the quality measures are
based on performance on 9 of the 18 QMs
that are currently posted on the Nursing
Home Compare web site
– Based on MDS 3.0 assessments
• Include 7 Long-Stay (LS) measures and 2
Short-Stay (SS) measures
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20. Long-Stay Residents
• Percent of residents whose need for help with activities
of daily living has increased
• Percent of high risk residents with pressure sores
• Percent of residents who have/had a catheter inserted
and left in their bladder
• Percent of residents who were physically restrained
• Percent of residents with a urinary tract infection
• Percent of residents who self-report moderate to
severe pain
• Percent of residents experiencing one or more falls
with major injury
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21. Short Stay Residents
• Percent of residents with pressure ulcers
(sores) that are new or worsened
• Percent of residents who self-report moderate
to severe pain
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22. Included Assessments
• Long Stay measures are included in the score if
the measure can be calculated for at least 30
assessments (summed across three quarters of
data)
• Short Stay measures are included in the score
only if data are available for at least 20
assessments
• Ratings are calculated using the three most
recent quarters for which data are available
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23. Five-Star Quality Score Calculation
MDS 2.0 MDS 3.0
ADL measure weighted higher than other ADL measure weighted equally with other
measures measures
ADL measure ranked in percentiles based ADL measure ranked in deciles based on
on State distribution State distribution
All non-ADL measures ranked in quintiles All non-ADL measures ranked in
based on National distribution percentiles based on National distribution
Points assigned according to quintiles Points assigned according to percentiles
Total possible score ranges from 0-136 Total possible score ranges from 9-900
points points
Changes in the Five-Star Quality Domain calculation from MDS 2.0 to MDS 3.0
requires attention from providers
• The basic premise is the same: lower QM rates=higher point values
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25. Quality Measure Score Thresholds
• Cut points for the QMs were set based on the QM
distributions averaged across Q2-Q4 of 2011
– will be maintained for a period of at least two years,
after which CMS will review
• These thresholds were set so that the overall
proportion of nursing homes in each rating category in
July 2012 (when the QM rating based on MDS 3.0 is
first reported) would be similar to what it was when
the MDS 2.0 QM rating was frozen in March 2011.
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27. Facility Star Rating Changes 2.0-3.0
New Quality Rating –
Number of Facilities Percent of Facilities
Old Quality Rating
-4 44 <1%
-3 445 3%
-2 1418 9%
-1 3205 21%
0 4967 33%
1 3251 21%
2 1435 9%
3 406 3%
4 62 <1%
Although the national distribution of star ratings remains the same, individual
facilities will see changes in their own Quality ratings
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28. CMS August Update to Nursing Home
Compare
• Shifted QM 3-quarter time period from
March-December 2011 to July 2011-March
2012
• Facilities saw a resulting change in their
publicly reported QM rates and star ratings
• Note the potential for changes with each
quarterly update to NHC
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29. Facility Star Rating Changes July-
August 2012
August 2012 Quality
Rating– Number of Facilities Percent of Facilities
July 2012 Quality Rating
-4 0 0%
-3 2 <1%
-2 60 <1%
-1 1857 12%
0 10425 68%
1 2939 19%
2 122 1%
3 10 <1%
4 0 0%
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30. Five-Star Changes and Your Facility
• Changes in the QMs can have an effect on
your facility’s Quality and Overall Five-Star
ratings
– Keep on top of CMS updates to Five-Star
• The challenge: to understand these changes to
put your facility’s rating in context and
communicate with residents, families and the
public
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32. How was the Five-Star Quality Rating
System designed to be used?
1. Help educate consumers about nursing home quality
2. Help improve provider quality
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33. How are Five-Star and MDS 3.0 QMs
actually being used?
SNF’s marketing departments
Hospital Discharge planners
HUD lending/re-financing
Plaintiff attorneys
Insurance brokers
ACOs/ “Bundles”
Medicare Advantage Plans
Media
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34. 1. Does the SNF that you work for have
a marketing strategy?
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35. 2. Does the SNF that you work for use
Five Star rating in marketing efforts?
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36. 3. Does the SNF that you work for use
Quality Measures (QMs) in marketing
efforts?
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37. 4. Does the SNF that you work for
sometimes lose referrals to other SNFs
with a higher Overall Five Star rating?
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38. 5. Does the SNF that you work for use
the Overall Five Star rating in their
marketing efforts to hospitals?
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39. 6. Does the SNF that you work for use
the Overall Five Star rating in their
marketing efforts to ACOs?
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40. 7. Does the SNF that you work for market
your Five Star components (i.e. Survey,
Quality, Staffing, etc.) separately?
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41. 8. Was the SNF that you work for “surprised”
by your 3.0 Quality Measure (QM) rating
compared to your 2.0 QM rating?
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42. 9. Do you find that the Quality Measures
(QMs) enhance your overall marketing
strategy?
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44. Five Data-Driven Strategies for Using Five-Star and
QMs to Market your Facilities More Effectively
1. Remember the who and why
2. Turn blunt instruments into sharp tools
3. Augment Five Star and QMs with other
key metrics
4. Don’t rely solely on yesterday’s news
5. Turn weaknesses into strengths
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45. How is Your Data Quality?
Proportion of MDS Assessments with Issues (>5,000,000
assessments)
17%
With Issues
Without Issues
83%
Of the 83% of assessments with issues, on average each
assessment had 2.41 issues.
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46. QM Strategies for Success
• Review MDS Data for accuracy
– Correct errors before CMS submission
– Identify processes that impact accurate MDS coding
• Supporting documentation
• Staff education
• Make Five-Star QMs part of facility quality
improvement process
– Trends and benchmarks
• Root Cause Analysis
– Review other CASPER QMs and related care processes
– Monitor positive outcomes to ensure good processes
are maintained
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47. Nursing Home Quality Assurance &
Performance Improvement (QAPI)
• Being rolled out by CMS in 2012
• Provides tools and resources to help facilities
meet existing QAA requirements
– Based on best practices
– Continuously identify and correct quality deficiencies
– Sustain performance improvement
• QAPI Element 3: Feedback, Data Systems and
Monitoring
– QMs can be incorporated into QAPI monitoring
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48. For More Information
• QM Users’ Manual
– www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/NursingHomeQualityInits/Downloads/MDS30QM-
Manual.pdf
• Five-Star User’s Guide
– www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/CertificationandComplianc/Downloads/usersguide.
pdf
• CMS’ QAPI Page
– www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/QAPI.html
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49. Thank You!
• Jennifer Gross Senior Healthcare Specialist
– jennifer.gross@pointright.com
• Jeff Merselis VP Business Development
– jeff.merselis@pointright.com
• http://www.pointright.com
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