Updated Nursing Home Compare Claims-Based Quality Measure Technical Specifications

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

Curious as to what constitutes the technical specs for the claims-based Quality Measures on Nursing Home Compare – your Five-Star rating? Are there covariates or risk adjustments? What data is used for my facility’s rating on NHC? Is any MDS data used for these claims-based measures?

The 27-page Nursing Home Compare Claims-Based Quality Measure Technical Specifications released on July 25, 2018 will help answer these questions and more for you. In this release, Abt Associates updated:

  • “The specifications for the Number of Hospitalizations per 1,000 Long-Stay Resident Days measure, including details on the numerator and denominator for the measure, exclusions, and the measure calculation methodology. The technical specifications will be updated with details on the risk-adjustment model prior to this measure being posted on Nursing Home Compare in October 2018.
  • (Added) MDS variables to the risk-adjustment models of the short-stay, claims-based quality measure and updates the coefficients for each variable, based on data from October 1, 2016 to September 30, 2017.”

The Claims-Based measures addressed are:

  • Percentage of Short-Stay Residents Who Were Re-Hospitalized After a Nursing Home Admission (This claims-based quality measure was first reported by CMS in April 2016 and integrated into the Five-Star Quality Rating System in July 2016.)
  • Number of Hospitalizations Per 1,000 Long-Stay Resident Days (This claims-based quality measure is new to Nursing Home Compare and will be reported starting in October 2018.)
  • Short-Stay Residents Who Have Had an Outpatient Emergency Department Visit (This claims-based quality measure was first reported by CMS in April 2016 and integrated into the Five-Star Quality Rating System in July 2016.)
  • Percentage of Short-Stay Residents Who Were Successfully Discharged to the Community (This claims-based quality measure was first reported by CMS in April 2016 and integrated into the Five-Star Quality Rating System in July 2016.)

Tip: MDS data is used/considered on these Claims-Based Measures so it’s imperative that you code each and every MDS 3.0 Item Set accurately!