SNF Healthcare-Associated Infections Requiring Hospitalization for SNF QRP

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

Acumen (CMS Contractor) has posted the Technical Report: Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization for the Skilled Nursing Facility Quality Reporting Program.  This 89-page report carries a February 2021 date.

“This report presents the SNF HAI technical measure specifications. Section 2 provides an overview of the measure and is a high-level summary of the key features of the measure that are described in detail in the remaining sections of the document. Section 3 describes the methodology used to construct the SNF HAI measure including its data sources, study population, measure outcome, regression model, and steps for calculating the final measure score. Section 4 discusses SNF HAI measure testing including the measure’s reportability, variability, reliability, and validity testing results. Appendix A displays the ICD-10 codes used to identify HAI conditions included in the measure. Appendix B presents the results of the risk adjustment model. Lastly, Appendix C details a flow chart for calculating the measure.

Monitoring the occurrence of HAIs among SNF residents can provide valuable information about a SNF’s quality of care. Most HAIs are preventable as they are often the result of poor processes and structures of care. A report from OIG (2014) estimated that one in four adverse events among SNF residents are due to HAIs, and more than half of all HAIs are potentially preventable. Typically, HAIs result from inadequate patient management following a medical intervention, such as surgery or device implementation, or poor adherence to protocol and antibiotic stewardship guidelines. Several provider characteristics are also related to HAIs including staffing levels (e.g., high turnover, low staff-to-resident ratios, etc.), facility structure characteristics (e.g., national chain membership, high occupancy rates, etc.), and adoption or lack thereof of infection surveillance and prevention policies. Inadequate prevention and treatment of HAIs is likely to result in poor health care outcomes for residents and wasteful resource use. For example, HAIs are associated with longer lengths of stay, use of higher-intensity care, increased mortality, and high health care costs. Given the wasteful resource use and economic burden that HAIs present, as well as the fact that there are currently no NQF endorsed measures that capture several types of severe infections attributable to the SNF setting in one composite score, the SNF HAI measure has the potential to provide actionable data on infection rates that can target quality improvement.

The purpose of the SNF HAI measure is to estimate the risk-standardized rate of HAIs that are acquired during SNF care and result in hospitalization in one composite score. Unlike other HAI measures that target specific infections, this measure targets all HAIs that are serious enough to require transfer to an acute care hospital. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs acquired during SNF care, when compared to their peers and to the national average HAI rate. Implementation of the SNF HAI measure provides information about a facility’s adeptness in infection prevention and management. The measure is actionable as it has the potential to hold providers accountable as well as encourage them to improve the quality of care they deliver. Further, this measure promotes patient safety and increases the transparency of quality of care in the SNF setting.

The Improving Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the Secretary to specify resource use measures, on which post-acute care (PAC) providers, including skilled nursing facilities, are required to submit necessary data specified by the Secretary. The Centers for Medicare and Medicaid Services (CMS) has contracted with Acumen, LLC and RTI International to develop the SNF HAI measure under the Quality Measure & Assessment Instrument Development & Maintenance & QRP contract (75FCMC18D0015, Task Order 75FCMC19F0003).”