Revisions & Applications of the New LTCH CARE Data Set

Mary DalrympleManaging Director, LTRAX

Kristen Smith, MHA, PT Senior Consultant, Fleming-AOD

Overview

Objectives Review changes to LTCH CARE Data Set effective July 1

• Training & resources• Deletions & additions• Not assessed vs. voluntarily skipped

Review section for patient influenza vaccination• Data collection timelines• Revised submission deadlines • Coding instructions

Discuss clinical applications of new data collection for improved outcomes

LTCH CARE Data Set, v. 2.01

The Basics New LTCH CARE assessments go into effect on July 1 All assessment forms updated to v. 2.01

Reflect changes and additions to LTCH Quality Reporting New measure for patients assessed and appropriately given

seasonal flu vaccination Some extra and voluntary data collection removed Program interruption data collection added

Information & Resources

CMS Training Special Open Door Forums on new data set

• May 7: review of quality reporting measures and deadlinesDownload materials at http://cms.hhs.gov/Medicare/Quality-Initiatives-

Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Training.html

• June 12: details TBD

LTRAX Training Software training on using new data set in LTRAX

• June training sessionsLog in to LTRAX > Info/Links > Live Training CallsRecorded training will be available

Information & Resources

CMS LTCH QRP 2014 Training Material LTCH CARE Data Set Training Manual

• coding guide Top 10 Fatal Error Messages

Download materials at http://cms.hhs.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Training.html

CMS LTCH Quality Reporting Manual, v. 2 Manual updated for addition of influenza vaccination, other changes

Download at http://cms.hhs.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/index.html

Transition to New Data Set

Transition begins July 1

Required assessment depends on “target date” Admission = Admission Date Planned or Unplanned Discharge = Discharge Date Expired = Discharge Date (Date of Death)

Submission Assessments with target dates on or after July 1 must be

submitted using the new form (v. 2.01) and submission format. Assessments with target dates of June 30 or earlier should be

prepared and submitted using the original form (v. 1), even if submitted on July 1 or later.

Submission processing will check target date against submission file format.

Transition to New Data Set

A patient may have two different LTCH CARE Data Set versions for one stay Example: admitted June 15, discharged July 7

• Admission Assessment: original (v. 1) form• Discharge Assessment: new (v. 2.01) form

Assessments may still be submitted after July 1 using the old form (v. 1) when appropriate Target date always determines the appropriate version Corrections (modifications and/or inactivations) with target dates

before July 1 Assessments overlooked and never sent before July 1

Deletions

Patient Demographics (Admission Assessment) Education Lifetime Occupation(s)

Patient Pre-Admission Services (Admission Assessment) Primary Diagnosis (in previous setting) Services Received in the Last 2 Months

Patient Clinical Data (Discharge Assessments only) Comatose Function: Roll Left to Right Function: Sit to Lying Diagnosis: Malnutrition

Discharge Data (Discharge Assessments) Discharge Delay Reason for Discharge Delay Discharge Return Status

Deletions: Pressure Ulcers

Pressure Ulcer Data (Admission and Discharge Assessments) Dimensions of Unhealed Pressure Ulcer Most Severe Tissue Type for Any Pressure Ulcer

Pressure Ulcer Measure Covariates (Discharge Assessments only) Function: Lying to Sitting on Side of Bed Bowel Continence Diagnoses: PVD or PAD Diagnoses: Diabetes Height Weight

Additions

Program Interruptions (Planned and Unplanned Discharge Assessments) “an interruption in a patient's care given by an LTCH because of the

transfer of that patient to another hospital/facility per contractual agreement for services”

3 calendar days or less, where the day of transfer is counted as day one of the interruption

Influenza Vaccination (Admission and Discharge Assessments)

Program Interruption Questions

Program Interruption(s)A2500. Program Interruptions

• Yes• No

A2510. If A2500 = Yes, Number of Program Interruptions During this Stay in this Facility

• NumberA2520. If A2510 = 1 or more… Program Interruption Dates

A1. First Most Recent Interruption Start DateA2. First Most Recent Interruption End DateB1. Second Most Recent Interruption Start DateB2. Second Most Recent Interruption End DateC1. Third Most Recent Interruption Start DateC2. Third Most Recent Interruption End Date• MM/DD/YYYY

Not Assessed or Voluntarily Skipped

If you leave a question unanswered…

Not Assessed (also “no information” or “unknown”) You do not have access to the information to record it on the assessment. Submitted to CMS as a dash (-)

Voluntarily Skipped You choose not to answer an item that is voluntary. Only allowed as an answer on voluntary item Submitted to CMS as an equal sign (=)

General Rules Items required for calculating quality measures cannot be answered

with voluntarily skipped. Most voluntary items can be answered with not assessed or voluntarily

skipped, as appropriate for circumstances.

Voluntarily Skipped

Facility Data National Provider Identifier State Medicaid Provider Number

Patient Demographics Patient Middle Initial Patient Name Suffix Medicare Number Medicaid Number Ethnicity Need or Want Interpreter? Preferred Language Marital Status Payer Admitted From Discharge Location Program Interruptions

Patient Clinical Data Comatose Function: Roll Left and Right Function: Sit to Lying Diagnoses: Malnutrition

Pressure Ulcer Data Stage 1 Stage 2 POA Stage 3 POA Stage 4 POA Unstageable: Dressing Unstageable: Dressing POA Unstageable: Slough/Eschar Unstageable: Slough/Eschar POA Unstageable: DTI Unstageable: DTI POAs

New Required Data

Mandatory for Submission (fatal error if omitted) Facility CCN Patient First Name

Required for participation in LTCH Quality Reporting Program Influenza Vaccine (within designated time periods)

Patient Flu Vaccination

New LTCH QRP MeasurePatients who were assessed and appropriately given the seasonal influenza vaccination

First Year Data Collection Effects FY 2016 payment determination Data collected beginning Oct. 1, 2014, or whenever the vaccine

becomes available (whichever comes first) through Mar. 31, 2015* Submission deadlines piggyback on existing LTCH CARE assessment

submission deadlines (45 days after the end of the quarter)*• Q4 2014 data – due Feb. 15, 2015• Q1 2015 data – due May 15, 2105

Future Years Data Collection Oct. 1 or whenever the vaccine becomes available

(whichever comes first) through Mar. 31 of the following year* Data due with relevant LTCH CARE assessment submissions*

* as revised in the proposed FY 2015 IPPS/LTCH PPS rule

Patient Flu Vaccination

Assessments with New Section O Admission Planned Discharge Unplanned Discharge

Data Collection Questions appear on revised assessments (v. 2.01) as of July 1,

but data collection begins Oct. 1 (or whenever the vaccine becomes available)

Questions may not be “voluntarily skipped” but may be answered “not assessed”

“Not assessed” would be considered incomplete for purposes of participation in LTCH Quality Reporting Program

Patient Flu Vaccination Questions

O0250. Influenza VaccineA. Did the patient receive the influenza vaccine in this facility for this

year's influenza vaccination season? • Yes• No• Not assessed

B. If yes … Date influenza vaccine received• MM/DD/YYYY• Not assessed

C. If no … If influenza vaccine not received, state reason: • Patient not in facility during flu season • Received outside of this facility • Not eligible - medical contraindication • Offered and declined • Not offered • Inability to obtain influenza vaccine • None of the above • Not assessed

Assessing Flu Vaccination Status

1. Review the patient’s medical record to determine whether an influenza vaccine was received in the facility for this year’s influenza vaccination season. If vaccination status is unknown, proceed to the next step.

2. Ask the patient if he or she received an influenza vaccine outside of the facility for this year’s influenza vaccination season. Please also review (when available) the patient’s medical record from previous setting(s) (e.g., short-stay acute care hospital medical records). If influenza vaccination status is still unknown, proceed to the next step.

3. If the patient is unable to answer, then ask the same question of the responsible party/legal guardian and/or primary care physician. If vaccination status is still unknown, proceed to the next step.

4. If vaccination status cannot be determined, please refer to the standards of clinical practice to determine whether or not to administer the vaccine to the patient.

- LTCH Quality Reporting Manual, v.2

Not Received: Coding Instructions

Code patient not in facility during this year's influenza vaccination season, if patient was not in the facility during this year’s influenza vaccination season

Code received outside of this facility, if this includes influenza vaccination administered in any other setting (e.g., physician office, health fair, grocery store, hospital, fire station) during this year’s influenza vaccination season.

Code not eligible—medical contraindication, if influenza vaccination was not received due to medical contraindications, including allergic reaction to eggs or other vaccine component(s), a physician order not to immunize, or an acute febrile illness is present. However, the patient should be vaccinated if contraindications end.

Code offered and declined, if patient or responsible party/legal guardian has been informed of what is being offered and chooses not to accept the influenza vaccine.

Code not offered, if patient or responsible party/legal guardian was not offered the influenza vaccine.

Code inability to obtain vaccine due to a declared shortage, if influenza vaccine was unavailable at the facility due to declared vaccine shortage. However, the patient should be vaccinated once the facility receives the vaccine. The annual supply of inactivated influenza vaccine and the timing of its distribution cannot be guaranteed in any year.

Code none of the above, if none of the listed reasons describe why the influenza vaccine was not administered. This code is also used if the answer is unknown.

- LTCH Quality Reporting Manual, v.2

Preparation: Flu Vaccine Data Collection

Things to Consider Hospital policy and procedure Liaison training

• Requirements• Definition• Location in acute care documentation

Assessment, documentation and communication• Pre-admission• Admission: Nurse to Nurse

Clinical decision-making Data entry/reporting

Clinical Applications: Flu Vaccination

Data Collection Process

• Clinical liaisons during pre-admission assessment• Nurse report upon admission

Documentation• Location of information• Structure of the questions

Mirror the LTCH CARE assessment questions

Clinical Standards of Care Acute-care admissions Clinical decision-making

• Availability of information• Standards of clinical practice

Reporting: Flu Vaccination

Data Entry/Reporting Timelines

• New LTCH CARE Data• Flu vaccination season

Accuracy Validation

• Supporting documentation

Preparation: Program Interruptions

Data Collection Process

• Identify individual(s) responsible• Communication• Tracking

Documentation• Location of information• Include dates of transfer and return

Clinical Applications: Program Interruptions

Use of Information High volume of interruptions

• Reason• Source• Internal clinical resources and skills

Multiple interruptions• Appropriate level of care• Adequate information with ongoing clinical needs

Identify Opportunities for Improvement Clinical information and communication Clinical skills/competencies Physician resources

• Consulting physicians Clinical resources Protocols

Pressure Ulcer Data

Things to Consider Voluntarily skipped items

• Present on admission• Unstageable wounds

Impact on reporting process• Inconsistencies• Accuracy

Result of Voluntarily Skipping Items Lack of data

• Clinical presentation on admission• Resources• Progression of unstageable wounds

CMS QRP Measures

What Lies Ahead…. Additional measures

• Additions to LTCH Quality Reporting Program • IMPACT Act of 2014

Annual notification of non-compliance• Request of reconsideration

Public reporting of quality data Value-based purchasing/post-acute bundling

Questions?assistance@ltrax.com

Join us at the National LTRAX Quality & Compliance ConferenceMore information available at LTRAX.com