LTCH Lay of the Land: Reporting the LTCH CARE Data Set

July 30, 2012

Purpose

• LTCH Quality Reporting Program, specifically the LTCH CARE Data Set

• CMS guidance, training & transmission Dates & Deadlines

• LTRAX: LTCH CARE data collection & recent enhancements

• Discussion Staying Informed Transition & Implementation Hot Spots

LTCH QRP: What is it?

LTCH Quality Reporting Program• Is a feature of the 2010 Patient Protection & Affordable

Care Act Mandates quality reporting for LTCHs, IRFs & Hospice

• Brings post-acute care in line with mandates already in place for acute care

LTCH QRP: Purpose

• Improve quality• Improve safety• Minimize healthcare-associated

infections (HAIs) & adverse events• Improve coordination of care• Create more person- and family-centered care

Data Collection: Overview

• LTCH QRP requires LTCHs to submit patient datato CMS for the first time

• Data collection begins with Oct. 1 admissions• Data collected on all patients, regardless of payer• Penalty for not participating is a 2 percentage point

reduction in annual Medicare payment update• Affects payment beginning fiscal year 2014

(October 2013)

Data Collection: Details

• Beginning Oct. 1, LTCHs will be required to collect and submit data for 3 measures:

1. Patients with pressure ulcersthat are new or have worsened

2. Catheter Associated Urinary Tract Infection (CAUTI)

3. Central Line Catheter-Associated Bloodstream Infection (CLABSI)

Pressure Ulcers: Rationale

• Pressure Ulcers: percent of patients with one or more stage 2-4 pressure ulcers that are new or have worsened LTCH patients tend to be medically complex with

functional limitations, sometimes severe. Pressure ulcers can lead to serious, life-threatening

infections. Pressure ulcers are an increasingly common secondary

diagnosis across all settings.

Pressure Ulcers: Data Collection

• CMS developed the LTCH CARE Data Set: Patient assessment instrument Collects documentation for pressure ulcers, selected

pressure ulcer risk factors, patient demographics, and provider attestations

Admission, Planned Discharge, Unplanned Discharge, and Expired assessments

Submit electronically to CMS Used for all patients, regardless of payer

Pressure Ulcers: Data Collection

• Specific Pressure Ulcer Outcomes Measuredata contained within the LTCH CARE Data Set: CMS will accept assessments but throw a warning

if any of the following fields have been omitted: • GG0160C. Functional Mobility: Lying to sitting on side of bed• H0400. Bowel Continence• I0900. Peripheral Vascular Disease (PVD) or PAD• I2900. Diabetes Mellitus (DM)• K0200A. Height (inches)• K0200B. Weight (pounds)• M0800. Worsened since prior assessment:

– A. Stage 2 Pressure Ulcers– B. Stage 3 Pressure Ulcers– C. Stage 4 Pressure Ulcers

HAIs: Rationale

• CAUTI (catheter-associated urinary tract infection) Medical severity & common comorbidities

of LTCH patients make catheters common Most common healthcare-associated infection Largely preventable

• CLABSI (central line-associated bloodstream infection) Patients come to LTCHs from ICUs or step-down

units with central lines in place, or have them inserted at the LTCH

Largely preventable

HAIs: Data Collection

• CMS piggybacked on the CDC’s National Healthcare Safety Network CDC will report quarterly information to CMS LTCHs participate via NHSN web-based reporting

system

LTCH CARE: What’s New?

• Attestations Removal of the requirement that an RN attest

to completion of LTCH CARE assessments Removal of Assessment Coordinator language

• Transmission Specifications New v. 1.00.3 available

• LASER (CMS free tool) Test version expected late August Training material posted week of Aug. 27 Production version expected early September

CMS Guidance: Upcoming

• Long-awaited LTCH CARE FAQ: Promised “very soon”

• LTCH CARE Manual Draft available Revised & updated manual expected by mid-August

• CMS recorded training materials July 30: CMS.net & QEIS user registration Aug 27: assessment submission process,

assessment & validation reports• LTCH Open Door Forums

Aug. 16, Sept. 20, & Oct. 18• 2:30 p.m. to 4:00 p.m. EDT

LTCH CARE: Upcoming

• Five additional measures proposed for data collection beginning calendar year 2014: Patients given seasonal influenza vaccine Influenza vaccination among healthcare personnel Patients given pneumococcal vaccine Ventilator Bundle:

• Head of the bed greater than or equal to 30 degrees• Daily sedation interruption and assessment of readiness to wean• Peptic ulcer disease• Deep vein thrombosis prophylaxis• Daily oral care with Chlorhexidine

Restraint rate per 1,000 patient days• Effects fiscal year 2016 payment (Oct. 2015) • Mandated public reporting of quality data: TBD

LTRAX

• LTRAX is a complete outcomes system built specifically for long-term acute care hospitals. Contains complete system for completing all LTCH

CARE assessments and preparing transmission files:• Conforms to all CMS submission rules• Checks assessments for integrity and consistency• Scans assessments for any unmet requirements• Contains easy-to-follow logic and organization to smooth

workflow

Comprehensive assessment and outcomes system for significant LTCH patient populations:

• Ventilator and weaning assessments and outcomes• Wound assessments (PUSH & BWAT) and outcomes• Operational & clinical outcomes

LTRAX Modules

• Core Module: Patient assessments, including the LTCH CARE Data

Set completion and transmission file system• Additional components make it a single-source software

solution for LTCH needs: Pre-admission screening (on & offline) & referrals

outcomes Patient Satisfaction survey system and reporting Joint Commission ORYX® Performance Measurement

System

LTRAX: What’s New?

• Push-the-button solution to CMS Skin Conditions questions (Section M): Complete wound assessment(s) at admission and

discharge, including origin, stage, location Use an integrated wound assessment tool

• Bates-Jensen Wound Assessment Tool or• PUSH Tool 3.0

Push COPY button and Voila! LTRAX churns assessment data through CMS Skin

Conditions logic to answer LTCH CARE assessment questions

Coming Soon: link to more information for how LTRAX computed skin conditions question for each patient assessment

LTRAX: What’s New?

• Integrated interruptions logic: LTRAX warns when a user may be starting a duplicate

patient assessment. LTRAX warns when a user may be starting a new

Admission assessment when unnecessary (such as when a discharged patient returns within 3 days).

LTRAX ties sets of LTCH CARE assessments together when a patient’s admission and discharge pattern suggests an interrupted stay

• Additional questions allow a user to confirm or deny an interrupted stay

LTRAX: What’s New?

• Integrated LTCH CARE assessment printing: Prints all assessment types on the CMS LTCH CARE

Data Set forms PDF can be saved or printed

Discussion: Stay Informed

• Expect changes to clinical guidance Questions answered in the FAQ Revisions within manual Requirements for transmission

• Tune in to upcoming CMS calls & training Check their websites

• LTRAX resources Webinar series Mailing list

Discussion: Implementation

• DQMs: The Lynchpin• Data Entry Burden

Reduce duplicate data entry with HL7 imports Examine other reporting systems for duplication What’s in it for me? Capitalize on the data opportunity

• Roles & Responsibilities Trace the entire physical workflow Trial everything before Oct. 1

• Data entry: clinical expert or clerk? Stretch resources or add FTEs? Tie clinical expert’s data entry role to outcomes

Discussion: Hot Spots

• How will we get that information? Integrate LTCH CARE into pre-admission screening

process:• A1800. Admitted From• A1810. In the last 2 months• A1820. Primary Diagnosis in the previous setting

Patients expiring after discharge• How will we track workflow?

Assessment Reference Dates, Completion Dates & Submission Dates

• Learn and love your software

The Big Picture

• LTCH CARE data collection will establish the first industry-wide data set LTRAX benchmarking at 200+ LTCHs Ultimately illustrate the need for long-term acute care

in the post-acute spectrum• Data submission begins Oct. 1, 2012.• Payment penalties begin Oct. 1, 2013.

Resources

• LTRAX www.ltrax.com 202-872-1033 assistance@ltrax.com

• CMS LTCH Quality Reporting Program: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-

Reporting/index.html

LTCHQualityQuestions@cms.hhs.gov• QIES Technical Support Office

www.qtso.com• LTCH QRP Technical Issues Help Desk

877-201-4721 888-477-7871 (fax) help@qtso.com