Nursing Home Acuity Workgroup

  • Meeting 1 is also available in Portable Document Foramt (PDF)

Nursing Home Acuity Workgroup

Meeting #1

May 20, 2019

Agenda

  • Welcome and Introduction of Nursing Home Acuity Workgroup Members
  • Schedule of Nursing Home Acuity Workgroup Meetings
  • Review of Statutory Nursing Home Acuity Workgroup Requirements
  • Background Information and Data
  • Acuity Adjustment Process (Current vs. New)
  • Five Representative Actual Resident Acuity Scores
  • Today´s Workgroup Discussion
  • Next Meeting

Nursing Home Acuity Workgroup Overview and Introductions

  • The Nursing Home Acuity Workgroup was established by the State Fiscal year 2019–20 Enacted Budget (Chapter 57 of the Laws of 2019 – Part G).
  • The Department of Health (DOH) is charged with convening and chairing the Workgroup.
  • Individual members of the Workgroup include representatives of:
    • Nursing Homes (Proprietary, Voluntary, and Public)
    • Statewide Associations of Nursing Homes
    • Case Mix Experts
  • The Department is pleased to welcome the members of the NH Acuity Workgroup and appreciates your participation and collaboration.
Michael Ogborn, Chair of Workgroup, Department of Health
Andrea Brindisi Paragon Management Dov Lebovic Concourse Rehab and Nursing Center
Christopher Koenig Niagara Lutheran Health System Gedalia Klein Centers Business Office
Christine Pesiri Southern New York Association Dr. Jeffrey Rubin Post Acute Partners
Dan Heim LeadingAge New York James McGregor 1199SEIU United Healthcare Workers East
Darius Kirstein LeadingAge New York John Murray Loretto Health and Rehab
David Berkowitz Kings Harbor Multicare Center Larry Slatky Albany County Nursing Home
Douglas Wissmann Hillside Manor Rehab and Ext Care Center Mary Gracey-White Greater NY Health Care Facilities Association
Michael Balboni Greater NY Health Care Facilities Association Robert McLeod Hospital Association of New York
Michelle Synakowski Community Wellness Partners Robert Werner Parker Jewish Institute for HC & Rehab
Mitch Marsh ArchCare Robert Nasso The Bonadio Group
Mojdeh Rutigliano Hebrew Home at Riverdale Scott Amrhein Greater New York Hospital Association
Nancy Leveille NYS Health Facilities Association Sean Doolan Hinman Straub
Neil Heyman Southern New York Association Stephen Hanse NYS Health Facilities Association
Paul Rosenfeld Kingsbrook Jewish Medical Center  

Nursing Home Acuity Workgroup Meetings

Meeting Purpose Date
Meeting #1 (today) Review recent case mix data and related analyses with respect to the implementation of the July 1, 2019 change in methodology.

Workgroup members offer recommendations on how to:
  • Improve future practice regarding accuracy in the minimum data set (MDS) collection process; and
  • Reduce or eliminate abusive practices to ensure the appropriate acuity for residential health care residents.
 May 22, 2019 11 a.m. – 1:00 p.m.
Meeting #2 Workgroup members offer recommendations on how to revise the MDS collection process related to the proposed Federal Patient Driven Payment Model (PDPM). Discussion of Workgroup Recommendations. June 13, 2019 11:00 a.m. – 1:00 p.m.
Meeting #3 Final review of Workgroup Recommendations for report due June 30, 2019. June 27, 2019 11:00 a.m. – 1:00 p.m.

Nursing Home Acuity Workgroup

(Chapter 57, Laws of 2019)

  • The Workgroup shall review:
    • Recent case mix data and related analyses conducted by the Department with respect to the Department´s implementation of the July 1, 2019 change in methodology;
    • The Department´s minimum data set collection process; an
    • Case mix adjustments authorized under subparagraph (ii) of paragraph (b) of subdivision 2–b of section 2808 of the Public Health Law.
  • Such review shall seek to promote a higher degree of accuracy in the minimum data set data, and target abuses.
  • The Workgroup may offer recommendations on how to:
    • Improve future practice regarding accuracy in the minimum data set collection process; and
    • Reduce or eliminate abusive practices.
  • In developing such recommendations, the Workgroup shall ensure that the collection process and case mix adjustment recognizes the appropriate acuity for residential health care residents.
  • The Workgroup may provide recommendations regarding the:
    • Proposed Federal Patient Driven Payment Model; and
    • Administrative complexity in revising the minimum data set collection and rate promulgation processes.
  • Notwithstanding any changes in Federal law or regulation relating to nursing home acuity reimbursement, the Workgroup shall report its recommendations no later than June 30, 2019.

Background

  • NYS Public Health Law requires the Department to make case mix adjustments to Nursing Home fee–for–service rates in January and July of each year.
  • NH are required to submit patient acuity assessments to CMS within 13 days of admission and every 92 days thereafter.

Current Acuity Adjustment Process

  • From January 2009 adjustment to January 2019 adjustment, the Department utilized only one assessment to measure acuity for each rate change.
  • In choosing the one assessment, the Department looks back 92 days and looks forward 13 days and chooses the one closest to an arbitrary census date (the last Wednesday in January and July).
  • All other assessments are excluded from the calculation
Statewide Average Acuity Scores

Statewide Average AcuityScores
January, April and July 2018 (All Facilities)

Statewide Average Acuity Scores

Residents by Category
January, April, and July 2018 (All Facilities)

Statewide Average Acuity Scores

Acuity Adjustment Process (Current vs. New)

Current Process New Process
Nursing Homes submit patient acuity assessments at least every 92 days to CMS. No change.
Nursing Homes submit census rosters to the Department. Census roster no longer required.
Only one assessment per resident used to calculate rate. DOH will use all available assessments.

Five Representative Resident Acuity Scores

Assessment Date Acuity Score Current Process Acuity Score closest to Census Date New Process Average Acuity Score
Resident 1 9/21/18 0.72 1.53 1.13
12/21/18 1.53
Resident 2 8/10/18 0.78 1.22 0.93
11/6/18 0.78
12/31/18 1.22
Resident 3 9/28/18 0.79 1.37 1.08
12/28/18 1.37
Resident 4 10/3/18 1.96 1.27 1.45
12/28/18 1.12
1/29/19 1.27
Resident 5 10/7/18 1.40 0.86 0.99
12/20/18 0.72
1/30/19 0.86

Today´s Nursing Home Acuity Workgroup Discussion

Workgroup Discussion: Improve Future Practice Regarding Accuracy in MDS Collection Process.
  • What steps need to be taken to ensure data is accurate (Facilities, DOH, CMS)?
  • What changes, if any, would make collection of data more efficient?
  • Are there options to ensure quality of data prior to submission to CMS?
Workgroup Discussion: Reduce or Eliminate Abusive Practices to Ensure Appropriate Acuity for Residential Health Care Residents.
  • To what extent do such practices exit today?
  • What, if any, quality assurance/monitoring processes should be established?

Next Meeting

  • Next Meeting
    • Topic:
      • Workgroup members offer recommendations on potential revisions to MDS collection process related to the proposed Federal Patient Driven Payment Model (PDPM).
      • Discussion of Workgroup Recommendations.
    • Date: Thursday, June 13, 2019 11 a.m. – 1:00 p.m.
    • Location: One Commerce Plaza, Conference Room 1613
  • Final Meeting
    • Topic: Final Discussion of Workgroup Recommendations
    • Date: Thursday, June 27, 2019 11 a.m. – 1:00 p.m.
    • Location: One Commerce Plaza, Conference Room 1613
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