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New Long Stay Quality Measures (QMs): Unplanned Hospitalizations or Outpatient Observation Stays

Hear Ye, Hear Ye! The new Long Stay Quality Measure for hospitalizations are to be posted on Nursing Home Compare in October 2018. The formal name for this measure is Number of Hospitalizations per 1,000 Long-Stay Resident Days.

What does this mean for your community? Well, it is imperative that the whole house is incorporated in your scope of focus when it comes to re-hospitalization mitigation. Due to Value Based Purchasing benchmarks and the CMS 5 Star Quality Rating QMs concerning short term (ST) residents with outpatient ER visits as well as ST residents who were re-hospitalized for skilled nursing facilities, many sites incorporate re-hospitalization analyses into their QAPI program. Does your analysis of residents who are transferred to the hospital (unplanned) include your long-term resident population?

A little bit about how this new Long Stay Measure will work. CMS is concerned that, if a nursing home sends many residents back to the hospital, it may indicate that the nursing home is not properly assessing or taking care of its residents who are admitted to the nursing home from a hospital. Therefore, this measure will report the ratio of unplanned hospitalizations per 1,000 long stay resident days. Higher values of the long stay hospitalizations measure indicate worse performance on the measure.

The long stay hospitalizations measure determines the number of unplanned inpatient admissions or outpatient observation stays that occurred among permanent (i.e. long stay) residents of a nursing home during a one-year period.

The numerator for the measure is the number of admissions to an acute care or critical access hospital, for an inpatient or outpatient observation stay, occurring while the individual is a long-term nursing home resident.

The denominator includes Medicare FFS enrollees with a single stay or sequence of stays during which the individual resides in the nursing home for a total of 101 days or more without a gap of 30 contiguous days living in the community or other institution. The denominator is the total number of days (in thousands) during the target period that all long stay residents were in the nursing home facility after they attained long-term resident status (i.e., after 100 cumulative days at the facility).

Having a focus group in your center assigned to review each hospital transfer for your long stay residents that was unplanned, with a report that includes any identified patterns, reporting back to the QAPI team is a major step to reduction in unnecessary hospitalizations.

Written By: Elisa Bovee, MS, OTR/L, Vice President of Clinical Strategies
Elisa's #HigherCalling: "I am a patient advocate of function, through teaching caretakers in long-term care."