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1 Institute of Medicine IOM IOM
2 2007 Nursing home reform Act Omnibus Budget Reconciliation Act of 1987 OBRA872007a OBRA (certification) Minimum Data SetMDS 2007 MDS Quality Indicators QI QI 2007 MDS Resource Utilization Group RUG RUG MDS QI a Nursing Home Compare NHC MDS Quality Measures QM
3 (2008) (2007a, 2007b) (2007) (2008) (2009) (NHC) MDS (1997) (2006)
4 MDS Center of Medicare and Medicaid ServicesCMS MDS CMS
5 CMS Division of Nursing Home, Chronic Care Policy, Center of Medicaid and State Operation, Medicare Hospice policy Chief Executive Officer, Nursing Home administrator, Executive Director of Hospice (Homecrest House) CMS Value-Based
6 Purchasing VBPCMS VBP MDS QM NHC NHC QI (surveyor) (unannounced) 2007CMS (Quality of Life) CMS OBRA87
7 (resident-centered) (outcome-oriented) OBRA87 (private argent) OBRA87 Quality Indicator Survey QIS MDS QI QI 2007b QIS MDS PC MDS (medical record) QI (national threshold) PC Data collection tool DCT DCT QI
8 NH (isolated) (pattern) (widespread) J C3 C1C2 K C3 C1C2 L C3 C1C2 G C2 C1 H C2 C1 I C3 C1TM D C1 C2 E C1 C2 F C2 C1 A B C CMS (2010) State Operation Manual Chapter 7 Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities (2008) P52 C1 C2 C3 TM Online Survey Certification And Reporting systemos- CAR NHC 2007a A~L 2008 J
9 G CMS Quality of Life QOL (life safety) (2007b)
10 (2007) MDS (QIS) 2007QM QI (highly regulated) (conversation) (talk)mds
11 RUG (Prospect Payment System) RUG Fries RUG Version 3 RUG (Extensive service) RUG Version 4RUG (staff time study and resource intensity verification; STRIVE) RUG RUG RUG ADL ADL Bed mobilitytransfertoilet useeating (Patient Health Questionnaire 9)
12 RUG RUG Category Rehab Level ADL Levels Rehab+Extensive Ultra High Very High High Medium Low RUL RVL RHL RML RLX RUX RVX RHX RMX RLX Rehabilitation Ultra High Very High High Medium Low RUA RVA RHA RMA RLA RUB RVB RHB RMB RLA RUC RVC RHC RMC RLB Extensive Services ES1, ES2, ES3 Special High HB HC HD HE Special Low LB LC LD LE Clinically Complex CA CB CC CD CE Behavioral Symptoms and Cognitive Performance BA BB Reduced Physical Function PA PB PC PD PE CMS SNF PPS Charges and RUG ADL RUGRUG RUG
13 (Cost Report) CMS Medicare Recovery Audit Contractor (RAC) (Cora, 2011) P4P (Pay for Performance, P4P) Kuhmerker and Hartmen (2007) P4P P4P P4P Becky et al (2009) P4P P4P P4P
14 Beckly et al (2009) P4P Georgia Nursing Home Quality Initiative Iowa Accountability Measures Incentive Program Kansas Nursing Facility Quality and Efficiency Outcome Incentive Factor Minnesota Add-on Ohio Add-on Quality Quality Oklahoma Focus on Excellence Utah Nursing Home Quality Improvement Initiative Beckly et al (2007) P4-5 Table 1 Description of Pay for Performance Programs in Nursing Home P4P NA NA NA NA CMS P4P Value-Based Purchasing (VBP) P4P
15 (Jordan et al, 2012) VBP (Staffing) (Potentially avoidable hospitalizations) MDS QM (Outcomes from State Survey Inspections) NHC (Health Inspection Rating, Staffing Rating, Quality Measures Rating) (Overall Rating) (Inspection and Complains) OSCAR Level of Harm Residents Affected
16 Level of Harm Residents Affected (Health Inspection Rating) (Staffing Rating) QM (Quality Measures Rating) (Fines) (Payment Denials) NHC
17 Value-Based Purchasing (Nursing Home Compare) (Quality Measure, QM) MDS MDS MDS
18 MDS
19 QI QI QM NHC P4P P4P P4P QOL
20 P4P QOL QI QM QI QM 2010 NY (B)
21 (2007) Vol. 48 No. 1 pp (2008) No. 167 pp (2007a) Vol. 79 No. 4 pp (2007b) Vol. 80 No. 2 pp (2007) Vol. 48 No. 1 pp (2007) Vol. 44 No. 3 pp (2008) Vol. 45 No. 1 pp49-57 (2010) pp (2009) Vol. 50 No. 1 pp (2011) Vol. 6 pp20-41 (2006) (1999) MDS, RUGs Vol. 33 No. 3 pp45-59 Cora DE (2011) CMS auditing series: RAC Attack. Health Capital Vol. 4 No. 9 Becky et al (2009) Pay for Performance in Nursing Homes. Health Care
22 Financing Review Vol. 30 No. 3 pp1-13 Jordan et al (2012) Value-Based Purchasing: National Program to Move from Volume to Value New England Journal of Medicine Vol. 367 pp Kuhmerker and Hartmen. (2008) Pay-for-Performance in State Medicaid Programs: A survey of State Medicaid Directors and Programs, id= Nursing Home Compare Home Page Centers for Medicare and Medicaid Services (2010) State Operation Manual Chapter 7 Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities pp www. cms. gov / Medicare / Provider-Enrollment-and-Certification / Survey CertificationGenInfo/index.html?redirect=/SurveyCertificationGenInfo/
15 6 9 3 18 9 1 17 244 1 15 7-1 - - 2 - ( 244 2 8 ) 17.9.5No35 17 7-3 - 0% 20% 40% 60% 80% 100% (1,795) 38.7% (2,844) 61.3% 34.1 (329) 83.4 (131) 65.9 (635) 16.6 (26) 38.2 (1265) 61.8 (2048) (N=4639) 34.1
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