nursing facility rates & policy division 1 ltc issues committee: nursing home report card update...

1Nursing Facility Rates & Policy DivisionNursing Facility Rates & Policy Division

LTC Issues Committee:

Nursing Home Report Card Update

July 24, 2007

Teresa Lewis


Minnesota Nursing Home Report Card

• WHY:– Transparency to consumers– Provider benchmarking and quality improvement

• HOW:– Nursing homes selected by geographical areas– Facility assigned 1-5 stars on each of seven

dimensions

http://www.health.state.mn.us/nhreportcard/


Minnesota NursingHome Report Card

Quality Measures - update frequency• Resident quality of life ratings - annually• Minnesota quality indicators - quarterly• Hours of direct care - annually• Staff retention - annually• Temporary staffing agency use - annually• Proportion of single rooms - quarterly• State inspection results – quarterly


User Priority ofQuality Measures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Quality Measures

% S

elec

tin

g

10/06-1/07 82.9% 62.2% 64.0% 43.2% 24.1% 13.9% 9.5%

2/07-6/07 81.5% 62.5% 60.2% 43.7% 28.4% 16.1% 7.5%

Quality of Life

MDH Inspection

s

MDS Quality

Indicators

Staffing (HPRD)

Staff Retention

Single-Bed Rooms

Use of Pool Staff


Report Card Usage

Unique Visitors to NH Report Card

0

500

1,000

1,500

2,000

2,500

Oct 06 Nov 06 Dec 06 Jan 07 Feb 07 Mar 07 Apr 07 May07

Jun 07

Major Report Card Updates


Minnesota NursingHome Report Card

Enhancements being considered• Format• Drill down• Refine scoring of MDH measure• Add measures for family satisfaction,

environment• Add non-MA facilities• Enable special focus on areas such as short

stay, dementia• DHS is interested in developing report cards

for other provider types


Quality of Life Trends

• 2007 data pending due to risk adjustment• Overall risk-adjusted resident satisfaction for

2006: 82% • High points in 2006

– Staff treating residents with dignity– Staff adapting environment to residents (significant ↑)

• Areas to target– Resident reports of negative emotions– Staff offering meaningful activities– Most quality areas had small but significant declines

’05 to ‘06


Quality of Life TrendsSignificant Changes Using Paired T-Tests are Bolded

MN Average Risk-Adjusted Scores

Quality of Life Area 2005 2006 Difference

Dignity 96.5% 96.2% -0.3%

Environmental Adaptations 87.9% 88.2% 0.4%

Security 87.9% 86.7% -1.2%

Privacy 87.4% 86.4% -1.0%

Food Enjoyment 86.3% 84.8% -1.5%

Individuality 84.7% 84.2% -0.5%

Relationships 83.3% 81.9% -1.4%

Comfort 81.8% 81.9% 0.1%

Autonomy 83.6% 81.8% -1.9%

Satisfaction 83.7% 81.8% -2.0%

Overall Score 82.2% 81.7% -0.5%

Mood 69.7% 69.4% -0.2%

Meaningful Activity 68.2% 68.5% 0.3%


Quality of Life TrendsChange in Risk-Adjusted QOL Scores

(2005 to 2006)

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

Significant Improvement

Significant Decline


Quality of Life Update

• Interviews done Feb – May 2007• Over 14,000 valid surveys• NFs more satisfied with overall process

– 2005: 89%– 2006: 94%– 2007: 95%

• Anticipated result timelines:– Observed results were to NFs mailed in early July– Risk-adjusted results on Report Card in July


Clinical Quality Indicators Trends

• 24 risk-adjusted care processes and outcomes

• Total change from 7/2004 to 12/2006– 20 QIs improved – Best: Pain, physical restraints, weight loss– Areas to target: Falls, burns/skin tears/cuts,

mobility


Clinical Quality Indicators Trends

Total Improvement in Risk-Adjusted QIs (July 2004 - Dec 2006)

-0.01

0.00

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08 Significant Improvement


Clinical Quality Indicators Update

• Psychoactive drug QIs now updated to reflect new clinical guidance

• 2006 Q1-4 QI report mailed to NFs in late June– Observed and risk-adjusted rates– Facility ranks compared to rest of state– Points received


Risk Adjustment

• QoL/RS scores adjusted for resident age, gender, cognitive/physical status & LOS; facility location and average resident LOS

• QIs adjusted for resident age, gender, diagnoses, functional status, and health conditions

• Empirical Bayes estimates from multilevel models


Direct Care StaffingTrends

Wage & Acuity-Adjusted Direct Care Staffing

4.744.22 4.49

5.23

4.264.73

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Hospital Board and Care Standard

Provider Type

Hou

rs/R

esid

ent

Day

2004

2005

• Hospital and standard NFs significantly increased staffing ‘04 to ’05• Data needed for this measure was not collected in prior years


Staff Retention TrendsStaff Retention

71.7% 72.2% 71.8%

0%

20%

40%

60%

80%

Oct 02 - Sept 03 Oct 03 - Sept 04 Oct 04 - Sept 05

• Retention has not changed significantly ’03 to ’05

All Direct Care StaffRNs, LPNs,

TMAs, CNAs


Temporary StaffingTrends

Supplemental Nursing Staff for NFs Using Any

4.09%

2.75%2.50%

0%

1%

2%

3%

4%

5%

Oct 02 - Sept03

Oct 03 - Sept04

Oct 04 - Sept05

• NFs using no supplemental nursing staff:-- 236 (59%) in 2003 -- 252 (64%) in 2004 -- 268 (68%) in 2005


Single-Bed Room Trends and Update

Percentage of Single-Bed Rooms

25.9%27.8% 29.4% 31.2%

0%

5%

10%

15%

20%

25%

30%

35%

Oct 05 Oct 06 Mar 07 July 07


Old MDH Inspection Trends

Current MDH Inspection Measure

9.69 9.54 9.40 9.45 9.40 9.31

0

2

4

6

8

10

Jan 05 -Jan 06

Apr 05 -Apr 06

July 05 -July 06

Sep 05 -Sep 06

Dec 05 -Dec 06

Mar 06 -Mar 07

Sco

re (0-1

0)

• Scores have declined slightly over past year


MDH State Inspection Update

Stars Awarded 5 4 3 2 2 1

Criterion 1Most Recent

SurveyMet Met

Met with Single-G

Exception

Met with Single-G

ExceptionNot-Met Not-Met

Criterion 2Complaints

Met Met Met Not-Met Met Not-Met

Criterion 3Prior Survey

Met N/A N/A N/A N/A N/A

Criterion 4Special Focus

FacilityMet Met N/A N/A N/A N/A

Criterion 5Total

DeficienciesMet N/A N/A N/A N/A N/A


MDH State Inspection Update

237

59 56 45 20

50

100

150

200

250

5 4 3 2 1

Revised Measure Stars

# o

f N

Fs


MDH State InspectionUpdate

NF Stars UsingOld QM

(Mar 07 data)

NF Stars Using New QM (Apr 07 data)

***** **** *** ** * Total

***** 222 56 30 31 1 340

** 7 2 26 11 1 47

* 0 0 0 3 0 3

Total 229 58 56 45 2 390


Questions?

Teresa LewisNursing Facility Rates and Policy Division

MN Department of Human ServicesPO Box 64973

St. Paul MN 55164-0973

Located at 540 Cedar St. in downtown St. Paul

Voice 651-431-4208 [email protected]

nursing facility rates & policy division 1 ltc issues committee: nursing home report card update...

Documents

nursing homes

supplemental nursing

mobility slide

cnas slide

geographical areas facility

quality areas

quality improvement

teresa lewis slide