Long-Term Care Survey Alert

If you've heard the changes are no big deal, you're going to be blindsided.

Did you know? Your facility will soon be fielding a whole new set of quality indicators for the survey process. And while the indicators are hardly birds of a different feather, they do represent a mixed flock.

Tentatively scheduled to roll out July 17, the new set of QIs incorporate the 12 chronic care quality measures and three post-acute quality measures (QMs) now used in the Nursing Home Quality Initiative and publicly reported at CMS' Nursing Home Compare Web site.

Review the new QIs/QMs at www.qtso.com/download/mds/MDS_QIQM_Tech_Specs.pdf.

Watch Out for Pain, Depression Quality Measures

The pain quality measure (based on coding at J2 of the MDS) will be a part of the QI/QM set. Depression will change from a prevalence-based to an incidence-based measure, which shows a resident's mood decline (coded in Section E) over time between two assessments. The latter approach provides more clinically meaningful information, notes Diane Brown, CEO of Brown LTC Consultants in Newton, MA.

The Centers for Medicare & Medicaid Services plans to issue a survey and certification letter to states about the new QIs/QMs and related revisions to the State Operations Manual.

Look for the letter at www.cms.hhs.gov/medicaid/survey-cert/letters.asp.

CMS' move to combine the QIs/QMs makes sense because a lot of facilities weren't paying that much attention to the QMs posted on the NHC Web site, which were months old by the time they came out, says

Nancy Augustine, MSN, RN, a consultant with LTCQ Inc. in Lexington, MA. "And the surveyors weren't required to use the quality measures in a formalized way," Augustine adds.

But that will change once the new QIs/QMs go into effect. Medicare PPS assessments will be part of the survey process for the three post-acute QMs, says Judy Wilhide, RAI manager for Virginia. "And the chronic care QMs will be part of the off-site survey sample selection."

Editor's Note: Once the QIs/QMs are in effect, Long-Term Care Survey Alert will bring you in depth coverage on how to code and manage the QIs for optimal survey outcomes.