REGULATORY & CLINICAL

Clinical Systems and Programs

There are two constant factors in the post-acute space

The first constant is that change will continue as providers redesign the care delivery to meet the needs of the customer and the industry initiatives, and the second constant is that everything a provider does is interdependent and interconnected to data and outcomes of the customer experience.

Redesign of health care service delivery is rapidly occurring. While reform can be difficult for providers, there are also great opportunities.

HOW WE HELP

Our approach at IHCA/INCAL is to align our members with the national initiatives of health care delivery reforms aimed at decreasing cost, reducing hospital readmissions, increasing quality and creating incentives to foster a more person-centered approach to care. Reviewing current operations for clinical and regulatory compliance performance is a critical component to remaining viable in the new health care market. We assist our members in the areas of:

Infection Control

Fall Management

Infection Prevention and Control

Skin Management and Pressure Injury Prevention

Bowel and Bladder Management

Pain Management

Behavior Services and Trauma-Informed Care

QAPI – Quality Assessment and Performance Improvement

Reduction of Psychoactive Medication Use

Transfer and Discharge Management

PDPM

CMS Five-Star Quality Reporting and Rating System

The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Reporting and Rating System to assist consumers, facilities and caregivers to compare quality care delivery with ease. The rating features an Overall Quality Rating (1-5 Stars) and on three types of performance measures, each of which has its own five-star rating (1-5).

Health Inspections Rating

Staffing Rating

Quality Measures (QMs) Rating

Nursing Home Quality Measures

New Quality Measures (QMs) are added or changed frequently. In addition, new payment models use the Five-Star Quality Rating System to compare, benchmark your performance and determine reimbursement for the care and services provided. Being aware of and understanding the impact of your Five-Star Quality Rating is critical to a provider’s success.

Nursing home quality measures have four intended purposes:

To give information about the quality of care at a nursing home in order to help a person choose a nursing home.
To give information about the care at a nursing home where you or a loved one already live
To give information to facilitate discussions with the nursing home regarding the quality of care
To give data to the nursing home to help providers in their quality improvement efforts

Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program

The SNF VBP Program rewards skilled nursing facilities (SNFs) with incentive payments based on the quality of care they provide to Medicare beneficiaries, as measured by a hospital readmissions measure.

Under the SNF VBP Program, SNFs:

Are evaluated by their performance on a hospital readmission measure;
Are scored on both improvement and achievement;
Receive quarterly confidential feedback reports containing information about their performance; and
Earn incentive payments based on their performance.