LTC Trend Tracker SM – A Quality And Financial Performance Improvement Tool

1. LTC Trend TrackerSM – A Quality And FinancialPerformance Improvement Tool October 22, 2009

2. LTC Trend Tracker • AHCA member benefit • No cost • Must submit Medicare patient days by RUG category on a monthly basis

3. Registration/Setup • Register at www.LTCTrendTracker.com • Central contact for each provider group • Identifies region(s) for organization • Authorizes employee access to view and submit information

4. Operational Uses • Medicare Patient Distribution – Compare your distribution to that of your peers using Utilization RUGs Report to analyze Medicare census by major RUG categories • Revenue And Cost – Compare your revenue and cost to your peers using the Cost Report section of the LTC Trend Tracker • Operational Issues - Compare your operations to your competitors using Five Star Rating Report, OSCAR Staffing Report, OSCAR Resident Report, OSCAR Survey Citations Report, and the NH Compare Quality Measures Report

5. Reports • Public information – OSCAR • Information from last 3 surveys • Staffing • Resident characteristics • Survey citations - health, complaint, life safety • Public information – Nursing Home Compare • Five Star ratings • Quality measures • Public information – CMS - Medicare cost report • Private information – RUGs patient days

6. Information Availability • Information available through public sources can be identifiable • Information obtained from providers will not be identifiable, it will be aggregated for analysis purposes

8. Geographic Area • Comparison areas • Geographic areas • All (nation) • State • County • City • Zip Code • Congressional District • Core Based Statistical Area

10. Peer Groups • General • All (Peers) • Your Organization • Geographic Structure • Facilities in an Urban area • Facilities in a Rural area

11. Peer Groups • Facility Type • Freestanding • Hospital-Based • Ownership • For-Profit • Not-For-Profit • Government

12. Peer Groups • Company Structure • In A Chain • Not In A Chain

14. Five Star Ratings • Ratings • Overall • Health Inspection • Direct Care Staffing • Registered Nurses Staffing • Quality Measures • Percentage of Facilities with 5-Star, 4-Star, 3-Star, 2-Star, and 1-Star Ratings for organization and peers

16. OSCAR Staffing Report • OSCAR Staffing Report • Total Staff Hours PPD • Total Nursing Hours PPD • Director Of Nursing/Assistant Director Of Nursing • Direct Care Staff • Registered Nurses • Licensed Practical Nurses • Nurses Aides

17. OSCAR Staffing Report • Total Therapy Hours PPD • Occupational Therapy • Physical Therapy • Speech Therapy • Other Therapy • Dietary Services Hours PPD • Housekeeping Hours PPD • Administration Hours PPD

18. OSCAR Staffing Report • Other Professional Hours PPD • Physician • Other Physician • Physician Extender • Podiatrist • Mental Health Services • Other Services Hours PPD • Personnel not otherwise recorded (i.e., laundry, librarian)

19. OSCAR Staffing Report • Additional breakdown by full-time, part-time, and contract percentage

21. OSCAR Resident Report • 1+ Assistance – ADL Dependence • Bathing • Dressing • Toilet Use • Transferring • Eating

22. OSCAR Resident Report • Bowel/Bladder Status • Catheterized • Catheterized Post Admission • Bladder Incontinence • Bowel Incontinence

23. OSCAR Resident Report • Mobility • Physically Restrained • Physically Restrained Without Order At Admission • Ambulatory • Bedfast • Contractures • Contractures Developed Post Admission • Dementia

24. OSCAR Resident Report • Skin Integrity • Pressure Sores – Stage 2+ • Pressure Sores – Stage 2+ Developed Post Admission • Special Care • Hospice • Dialysis • Pain Management Program

25. OSCAR Resident Report • Other • Advance Directives • Influenza Immunization • Pneumococcal Vaccination

27. OSCAR Citations ReportHealth Surveys • Survey Results • Average Number Of Tags • Deficiency Free Providers • Immediate Jeopardy • Substandard Quality Of Care • Deficiencies Greater Than Or Equal To “G” • Highest Scope And Severity • Select Up To 15 F-Tags • Scope And Severity • Percentage Of Peer Facilities With F-Tag

29. OSCAR Citation ReportComplaint Surveys • Survey Results • Number of Facilities with Complaint Investigations • Number of Facilities with Complaint Citations • Average Number Of Tags • Immediate Jeopardy • Substandard Quality Of Care • Deficiencies Greater Than Or Equal To “G” • Highest Scope And Severity • Select Up To 15 F-Tags • Scope And Severity • Percentage Of Peer Facilities With F-Tag

31. OSCAR Citation ReportCombined Report • Survey Results • Number of Facilities • Number of Facilities with Citations • Average Number of Tags • Deficiency Free Providers • Immediate Jeopardy • Substandard Quality of Care • Deficiencies Greater Than or Equal to “G” • Highest Scope and Severity • Select Up To 15 F-Tags • Scope and Severity • Percentage of Peer Facilities with F-Tag

33. OSCAR Citation ReportLife Safety Surveys • Survey Results • Average Number Of Tags • Deficiency Free Providers • Immediate Jeopardy • Deficiencies Greater Than Or Equal To “G” • Highest Scope And Severity • Select Up To 15 K-Tags • Scope And Severity • Percentage Of Peer Facilities With K-Tag

35. Cost Report • Occupancy • Occupancy Rate • Medicare Utilization • Medicare Average Length Of Stay – Days

36. Cost Report • Costs And Revenues • Net Income As Percentage Of Revenue • Total Revenue PPD • Days Accounts Receivable Sales Outstanding • Total Cost PPD • Nursing Cost PPD • Dietary Cost PPD • Administrative And General Cost PPD

37. Cost Report • Costs And Revenues (con’t) • Professional Liability Insurance Cost Per Bed • Direct Therapy Cost Per Medicare Therapy Day • Direct Non-Therapy Cost Per Medicare Therapy Day • Direct Pharmacy Cost Per Medicare Day

38. Cost Report • Staffing And Compensation • Total Staff Hours PPD • Average Staff Wage Rate • Average Contract Labor Wage Rate • Benefits As Percent Of Salary • Salary And Benefits As Percentage Of Total Cost • Bad Debt • Total Reimbursable Bad Debt Per Medicare Patient Day • Non-Dual Eligible Bad Debt Per Medicare Patient Day

40. Utilization RUGs Report • Average Facility Size – Number of Beds • Average Medicare Census • Average Medicare Rate PPD

41. Utilization RUGs Report • Major RUG Classification • Classification – Rehab Plus Extensive Services • Classification – Rehab • Classification – Extensive Services • Classification – Specialty Care • Classification – Clinically Complex • Classification – Impaired Cognition • Classification – Behavioral • Classification – Physical Function

42. Utilization RUGs Report • Therapy Intensity • Therapy Intensity – Ultra High • Therapy Intensity – Very High • Therapy Intensity – High • Therapy Intensity – Medium • Therapy Intensity – Low

43. Utilization RUGs Report • Other Statistics • Other Statistics – Clinically Complex Without Depression • Other Statistics – RUGs Without Restorative Nursing • Other Statistics – Medically Complex (Extensive, Specialty Care, Clinically Complex) • Other Statistics – Lowest ADL RUGs

45. Nursing Home Compare Quality Measures Report • Advancing Excellence Measures • Pain in Post Acute Residents, no adjustments • Pain, Inadequate Management, adjusted • Pressure Ulcers, High Risk, no adjustment • Physical Restraints, no adjustment

46. Nursing Home Compare Quality Measures Report • Post Acute Care • Delirium In Post Acute Residents, Adjusted • Pain In Post Acute Residents, No Adjustment (AE Goal) • Pressure Ulcers In Post Acute Residents, Adjusted • Influenza Vaccination Provided – PAC • Pneumococcal Vaccination Provided – PAC

47. Nursing Home Compare Quality Measures Report • Chronic Care • Physical Condition And Depression • Pain, Inadequate Management, Adjusted (AE Goal) • Pressure Ulcers, (High Risk), No Adjustment (AE Goal) • Pressure Ulcers, (Low Risk), No Adjustment • Physical Restraints, No Adjustment (AE Goal) • Depression/Anxious Mood Worsening, No Adjustment

48. Nursing Home Compare Quality Measures Report • Chronic Care • Physical Functioning And Weight Loss • Residents Who Lose Too Much Weight • Late Loss ADL Worsening, No Adjustment • Bedfast, No Adjustment • Locomotion Worsening, Adjusted • Urinary System • Indwelling Catheter, Adjusted • Incontinence, Bowel Or Bladder (Low Risk), No Adjustment • Urinary Tract Infections, No Adjustment

49. Nursing Home Compare Quality Measures Report • Chronic Care • Vaccination • Influenza Vaccination Provided • Pneumococcal Vaccination Provided

50. Thank You • To participate or request information: www.LTCTrendTracker.com Bill Hartung at 202-454-1283