Institute of Medicine IOM IOM
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 19972007 2007a Nursing Home Compare NHC MDS Quality Measures QM
1999 1984 (2008) (2007a, 2007b) (2007) (2008) (2009) (NHC) MDS (1997) (2006)
MDS Center of Medicare and Medicaid ServicesCMS MDS CMS
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
Purchasing VBPCMS VBP MDS QM NHC NHC QI (surveyor) (unannounced) 2007CMS (Quality of Life) CMS OBRA87
(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
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
G CMS Quality of Life QOL (life safety) (2007b)
(2007) MDS (QIS) 2007QM QI (highly regulated) (conversation) (talk)mds
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)
RUG RUG Category Rehab Level ADL Levels 0-1 2-5 6-10 11-14 15-16 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
(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
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
(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
Level of Harm Residents Affected (Health Inspection Rating) (Staffing Rating) QM (Quality Measures Rating) (Fines) (Payment Denials) NHC
Value-Based Purchasing (Nursing Home Compare) (Quality Measure, QM) MDS MDS MDS
MDS 20072011
QI QI QM NHC P4P P4P P4P QOL
P4P QOL QI QM QI QM 2010 NY (B)
(2007) Vol. 48 No. 1 pp153-166 1984 (2008) No. 167 pp 66-76 (2007a) Vol. 79 No. 4 pp131-150 (2007b) Vol. 80 No. 2 pp131-150 (2007) Vol. 48 No. 1 pp194-198 (2007) Vol. 44 No. 3 pp293-301 (2008) Vol. 45 No. 1 pp49-57 (2010) pp141-161 (2009) Vol. 50 No. 1 pp95-108 (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
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 pp292-295 Kuhmerker and Hartmen. (2008) Pay-for-Performance in State Medicaid Programs: A survey of State Medicaid Directors and Programs, http://cmmonwealthfund.org/publications/publications-show,htm?doc id=472891 Nursing Home Compare Home Page http://www.medicare.gov/nursinghomecompare/search.aspx?bhcp=1 Centers for Medicare and Medicaid Services (2010) State Operation Manual Chapter 7 Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities pp 1-158 http:// www. cms. gov / Medicare / Provider-Enrollment-and-Certification / Survey CertificationGenInfo/index.html?redirect=/SurveyCertificationGenInfo/