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Need to Know: New Long-Stay Claims-Based
Hospitalization Measure Now on Nursing
Home Compare By Susan Chenail, RN, CCM, RAC-CT, senior quality improvement analyst
THE
Centers for Medicare and Medicaid
Services (CMS) believes that residents
who return to the hospital frequently during their
nursing home stay for unplanned reasons are less
likely to be receiving proper assessments or care. In
an attempt to widen those included in hospitalization
measures, CMS has created a new measure that is
comprised of long-stay residents titled Number of
Hospitalizations Per 1,000 Long-Stay Resident Days.
This brand-new measure is not the measures we are
familiar with – for example, Percentage of Short-Stay
Residents Who Were Rehospitalized After a Nursing
Home Admission or Short-Stay Residents Who Have Had
an Outpatient Emergency Department Visit, used to
calculate the quality measure domain of the Nursing
Home Compare (NHC) Five-Star Quality Rating
System. This new hospitalization measure reports
the ratio of unplanned hospitalizations per 1,000
long-stay resident days. Keep in mind that this is a
claims-based measure which includes those residents
on traditional Medicare Fee for Service (FFS), and
it is also a long-stay measure which includes those
residents in the facility for more than 100 days. The
Nursing Home Compare Claims-Based Quality Measure
Technical Specifications September 2018 update contains
more details on the new measure, including purpose,
description, numerator, denominator and exclusions.
Short-Stay Residents Who Were Rehospitalized After a
Nursing Home Admission. The measure used in the
graph titled Short-Stay Emergency Department
Visits is Short-Stay Residents Who Have Had an
Outpatient Emergency Department Visit. In both
measures, a lower rate is better. The data was derived
from NHC reporting quarter July 2018 and the data
collection period of Oct. 1, 2016 through Sept. 30, 2017.
New York Non-Profits’ performance on both measures
was compared to that of their New York For-Profit,
New York State and National peer groups.
In the first graph depicting rehospitalization, the
vertical axis is the groups, and the horizontal axis
is the rate. Analysis of Short-Stay Rehospitalization
shows that New York Non-Profits are outperforming
their peers, faring 3 percent better than New York
For-Profit Nursing Homes, 5 percent better than New
York State and 13 percent better than the nation.
Quality Metrics was used to produce the following
graphs pertaining to utilization of hospital services.
The claims-based measure used in the graph titled
Short-Stay Rehospitalization is Percentage of
Adviser a publication of LeadingAge New York | Fall 2018
In the second graph depicting
emergency department visits, the
vertical axis is the groups, and
the horizontal axis is the rate.
Analysis of Short-Stay Emergency
Department Visits shows that