RUG and QM Reports Update

1. RUG and QM Reports Update Presented to State Veterans’ Homes Administrators Presented by Janet Barber National Program Manager, Data Mgmt. and Analytics Geriatrics and Extended Care Operations Department of Veterans Affairs

2. RAI/MDS • Resident Assessment Instrument/ Minimum Data Set • RAI/MDS was designed to facilitate achievement and maintenance of the resident’s highest practical level of well-being by identifying and documenting individual resident’s needs and strengths, and incorporating this information into the resident’s care plan

3. RUG Reports

4. What is a RUG? • Resource Utilization Group • This classification system uses information from the MDS assessment to classify nursing home residents into a series of groups representing the residents’ relative direct care resource requirements

5. RUG Basics1 • SVH reports will utilize RUG IV • There are 66 RUGs in the RUG IV classification system

6. RUG Basics2 • Eight major classification categories • Rehab plus Extensive Services • Rehabilitation • Extensive Services • Special Care High • Special Care Low • Clinically Complex • Behavioral Symptoms & Cognitive Performance • Reduced Physical Function

7. RUG report Facility: Any SVH Date Range:01-OCT-13 to 31-OCT-13 Creation Date:07-JAN-14 Average CMI Weight: 9.93 (Total CMI Weight / Total Assessments) Total Assessments: 171 Total CMI Weight: 1698.0 Number of assessments in this reporting month that were completed late. This is a count of late assessments for the reporting month, and may not have been used for the RUGS counts. Quarterlies : 0 Fulls : 0 Total : 0 RUG Model/Logic Version: 66/103 RUG Weight Set: MEDICARE RUGS Model 66 RURAL-FY2012 Reference: MDS 3.0 Users Manual

8. DOMAIN Assmt #Assmts with CMI Weight CMI Wt. SubDomain RUG (ADL Range) ADL this RUG & ADL this RUG Sub-Total ------------------------------------------------------------------------- 1. REHAB PLUS EXTENSIVE SERVICES ULTRA HIGH INTENSITY RUX (11-16) - - 66.0 0.0 RUL (2-10) - - 65.0 0.0 VERY HIGH INTENSITY RVX (11-16) - - 64.0 0.0 RVL (2-10) - - 62.0 0.0 HIGH INTENSITY RHX (11-16) - - 63.0 0.0 RHL (2-10) - - 57.0 0.0 MEDIUM INTENSITY RMX (11-16) - - 58.0 0.0 RML (2-10) - - 55.0 0.0 LOW INTENSITY RLX (2-16) - - 52.0 0.0 ----------------------------------------------------------- Category SubTotal 0 0.0

9. CMI • Each RUG group has a weighted value called Case Mix Index • Represents the relative use of resources for a resident • Case refers to nursing facility resident • Mix refers to the mixture of different types of residents cared for in the CLC

10. Things to consider1 • How do your residents fall into the various RUG categories? • Would first pay attention to the residents in the Reduced Physical Function and the Behavioral Symptoms & Cognitive Performance categories • These residents may be served better in a different level of care • They may be ready for assistive living or admission into your domiciliary • They may be ready for discharge home with home health services

11. Things to consider2 • You can determine the residents’ discharge goal by the coding in Section Q

12. Qm reports

13. What is a QM? • Quality Measure • One method for determining the quality of care in a nursing home is through the use of Quality Measures

14. What is a QM2 • Quality Measures are derived from resident assessment data (RAI/MDS) routinely collected on the residents at specified intervals during their stay • Measures are valid and reliable - based on the best research currently available

15. What is a QM3? • Measures are not intended to be benchmarks, thresholds, guidelines, or standards of care • Rather, • They are markers for facility trending and comparison • Allows facilities to monitor progress over time • They are pointers to potential problem areas/areas of possible weakness

16. The SVHs will be receiving from the VA the Annual survey process report (also called Surveyors Report). It contains all of the quality measures plus the addition of 4 immunization measures.

17. Short Stay vs. Long Stay • Short Stay Quality Measures: • Include all residents in an episode whose cumulative days in the facility is less than or equal to 100 days at the end of the target period • Long Stay Quality Measures: • Include all residents in an episode whose cumulative days in the facility is greater than or equal to 101 days at the end of the target period

18. Short Stay Measures • Percent of Residents who Self-Report Moderate to Severe Pain • Percent of Residents with Pressure Ulcers that are New or Worsened • Percent of Short-Stay Residents Who Newly Received an Antipsychotic Medication • Percent of Residents who were Assessed and Appropriately Given the Seasonal Influenza Vaccine • Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine

19. Long Stay Measures1 • Prevalence of Falls • Percent of Residents Experiencing One or More Falls with Major Injury • Percent of Residents who Self-Report Moderate to Severe Pain • Percent of High-Risk Residents with Pressure Ulcers • Percent of Long-stay Residents with a Urinary Tract Infection

20. Long Stay Measures2 • Percent of Low-Risk Residents Who Lose Control of their Bowels or Bladder • Residents Who Have/Had a Catheter Inserted and Left in Their Bladder • Percent of Residents Who Were Physically Restrained • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased

21. Long Stay Measures3 • Percent of Long-stay Residents Who Lose Too Much Weight • Percent of Residents Who have Depressive Symptoms • Prevalence of Antianxiety/Hypnotic Use • Percent of Long-Stay Residents Who Received An Antipsychotic Medication

22. Long Stay Measures4 • Prevalence of Behavior Symptoms Affecting Others • Percent of Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine • Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine

23. QM Report Description MsmtID Num Denom FAC Obs FAC Adj StatAvg VISNAvg NatlAvg NatPctl----------- ------ ---- ------ ------- ------- ------- ------- ------- -------Self-Report Moderate to Severe Pain[S] N001.01 3 20 15.0% - 17.8% 18.0% 22.4% 100.0% With Pressure Ulcers New or Worsened[S] N002.01 38 38 100.0% 100.0% 96.6% 94.1% 90.7% 100.0% Assessd + Appr Givn Seasonal Influenza Vaccine[S] N003.01 15 15 100.0% - 88.5% 92.6% 83.6% 100.0% Assessd + Appr Given the Pneumococcal Vaccine[S] N007.01 40 40 100.0% - 94.4% 92.5% 83.7% 100.0% Shrt Stay Who Newly Received an Antipsych Med[S] N011.01 2 7 28.6% - 17.8% 11.6% 05.5% 100.0% Expr One or More Falls with Major Injury[L] N013.01 8 207 03.9% - 03.7% 03.7% 03.5% 100.0% Self-Report Moderate to Severe Pain[L] N014.01 6 148 04.1% 55.1% 10.8% 10.2% 10.3% 100.0% High-Risk With Pressure Ulcers[L] N015.01 3 109 02.8% - 02.2% 04.8% 06.1% 100.0% Assessd + Appr Givn Seasonl Influenza Vaccine[L] N016.01 203 203 100.0% - 99.2% 99.3% 94.1% 100.0% Assessd + Appr Given Pneumococcal Vaccine[L] N020.01 208 208 100.0% - 98.9% 98.5% 96.1% 100.0% With a Urinary Tract Infection[L] N024.01 8 208 03.8% - 03.7% 05.3% 05.3% 100.0% Low Risk Who Lose Control of Bowel or Bladder[L] N025.01 1 2 50.0% - 50.5% 55.4% 59.5% 100.0% Have/Had a Catheter Insertd + Left in Bladder[L] N026.01 1 171 00.6% 52.8% 04.0% 04.2% 05.3% 100.0% Were Physically Restrained[L] N027.01 0 208 00.0% - 00.0% 00.5% 01.6% 00.0% Need for Help w/ Activities Daily Living Incr[L] N028.01 18 138 13.0% - 12.8% 14.2% 14.7% 100.0% Lose Too Much Weight[L] N029.01 16 208 07.7% - 07.5% 08.2% 07.6% 100.0% Have Depressive Symptoms[L] N030.01 1 187 00.5% - 05.3% 05.6% 04.9% 100.0% Received An Antipsychotic Medication[L] N031.02 70 208 33.7% - 29.5% 30.8% 25.8% 100.0% Had a Fall During their Episode of Care[L] N032.01 131 207 63.3% - 60.2% 58.4% 53.6% 100.0% AntianxietyOrHypntcMed+noEvidPsychotcOrRltdTrgtPrd[L] N033.01 0 75 00.0% - 00.0% 00.0% 00.0% 00.0% Behavr Symptoms Affect Others for Trgt Prd[L] N034.01 28 188 14.9% - 23.9% 26.9% 28.0% 100.0%