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Written by: Darlene D'Altorio-Jones (1959-2015) on Monday, April 8, 2013 Posted in: Inpatient Rehab

We have officially had six months of two quality indicators being reported under our belts in IRF (if you chose to participate), and you are probably wondering, ‘What next?’ How might the next set of quality indicators be introduced and where might they come from? Aren’t you at least curious about what industry experts have discussed regarding quality measures being proposed?

While at the 2013 Spring AMRPA conference a few weeks ago, I had the opportunity to listen to Anne Deutsch, RN, Phd, CRRN, Senior Research Public Health Analyst, RTI International; Clinical Research Scientist, Rehabilitation Institute of Chicago. She provided a quick update on the history of quality reporting including: the ‘Three Aims’ of CMS National Stategy, Better Health, Healthy People and Communities and Affordable Care.

In addition, she shared the six priorities specific to the National Quality Strategy and listed them as follows in her slides:

  1. Making care safer by reducing harm caused in the delivery of care.
  2. Ensuring that each person and family are engaged as partners in their care.
  3. Promoting effective communication and coordination of care.
  4. Promoting the most effective prevention and treatment practices for the leading causes of mortality (cardiovascular disease).
  5. Working with communities to promote wide use of best practices to enable healthy living.
  6. Making quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models.

A few of those items should peak your interest as to how that will affect your line of service, but for now, let’s just discuss Quality Measures under consideration for the LTC industry; which by the way includes IRF.

MAP is a public-private partnership created to provide input to the Department of Health and Human Services on the SELECTION of performance measures for public reporting and performance-based payment programs.  Additionally, MAP seeks industry leaders to comment and help guide thought generated to guide policy which may eventually be endorsed by the National Quality Forum (NQF) whose staff reviews, endorses and recommends use of standardized healthcare performance measures.  These steps eventually lead to policy and enforcement for participation in government paid services. At this point I hope your attending fully – eventually this process gets to you – the clinician and leaders of healthcare.

In January 2013,  MAP released a Pre-Rulemaking Draft report and many industry leaders made comments and recommendations.  The final report was recently published and is now available to review.

The MAP Pre-Rulemaking Report: 2013 Recommendations on Measures Under Consideration by HHS represents MAPs second annual round of input regarding the performance measures currently under consideration for use in federal programs. ”

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If you review this report,  pay attention to Section 7: Pre-Rulemaking Input on Post-Acute and Long-Term Care Performance Measurement Programs, as many organizations have voiced support and opposing discussions as to why 10 measures being discussed for inclusion in the Post Acute Care Service areas may or may not be the indicators to adopt, as we add additional quality and performance measurements to IRF Reporting.

Anne listed these additional measures being discussed to add to new or worsened pressure ulcers and CAUTI.

  • Influenza vaccination coverage among healthcare personnel
  • Percent of residents or patients who were assessed and appropriately given the seasonal influenza vaccine.
  • Percent of residents or patients assessed and appropriately given the pneumococcal vaccine.
  • Reliability adjusted central line-associated blood stream infection
  • Reliability adjusted catheter associated urinary tract infection
  • Reliability adjusted Clostridium difficile SIR measure
  • 30-day all-cause post IRF discharge hospital readmission measure
  • Functional change: change in motor score
  • Functional outcome;  change in mobility
  • Functional outcome measure; change in self-care

Think of these items in particular to the patient populations served in IRF.  How many come from hospitals already administering flu and pneumococcal vaccines?  Do you have many patients with central lines?  If functional change and outcomes are measured will they be based on functional measurement we all know and have been using for more than 10 years in IRF’s or will they wait until proposed CARE tool standards may be rolled out to the industry for continuum measurement?  These are all questions you too should consider and discuss with your staff. Get on board, and be certain your organizations and physicians are voicing your opinions this won’t be the last time comments will be accepted.

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