Quality

As part of the continuing efforts under President Biden’s initiative to improve nursing home transparency, safety and quality, and accountability, the U.S. Department of Health and Human Services announced new actions to reduce the inappropriate use of antipsychotic medications and to bring greater transparency about nursing home citations to families. Beginning this month, CMS will conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis.

This week CMS issued a final rule for the Calendar Year 2023 Physician Fee Schedule which includes updates and policy changes for Medicare payments and other Part B issues. Some of the changes include expanding access to behavioral health services by allowing certain health practitioners to provide and manage a beneficiary’s behavioral health needs; extending several telehealth services that are temporarily available for the COVID-19 public health emergency at least through calendar year 2023; and clarifying payment for dental examinations and treatments in more circumstances, such as prior to organ transplants and certain cardiac procedures beginning in calendar year 2023.

The Kaiser Family Foundation's new report, “Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature,” details their findings from an analysis of 62 studies published since 2016 comparing traditional Medicare to Medicare Advantage. The analysis reviewed beneficiary experience, affordability, service utilization, and quality measures. According to the report, the review “found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction.

Late yesterday CMS released a State Medicaid Director Letter (SMDL 22-003) providing guidance for the first-ever HCBS Quality Measure Set, the first of two planned guidance documents from CMS. The HCBS Quality Measure Set is included in the SMD, starting on page 14. The list of measures includes the NQF number (if applicable), measure steward, and data collection method, as well as information on whether each measure addresses section 1915(c) waiver assurances and/or can be used to assess access, LTSS rebalancing, and/or community integration and HCBS settings requirements.

The impact of COVID-19 on nursing facility residents and staff has brought increased attention to existing workforce issues that affect care quality and safety, including staffing shortages and high turnover rates. This analysis presents the most recent national and state-level data on nursing facility-reported staff shortages and describes the Biden Administration’s new policy initiatives to address issues in nursing facilities. National staff shortage trend data spans from May 2020, the first month when nursing facilities were required to report COVID-19 facility data to the CDC, through March 20, 2022, the most recent week of data available.

President Biden has announced a set of reforms, developed and implemented through the Department of Health and Human Services (HHS), to improve the safety and quality of nursing home care. The reforms are intended to ensure the following: Every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care; Poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars; and The public has better information about nursing home conditions so that they can find the best available options.

The CMS Office of Minority Health (OMH) has published a new report, Trends in Racial, Ethnic, Sex, and Rural-Urban Inequities in Health Care in Medicare Advantage: 2009-2018. Since 2015, CMS OMH has published annual reports highlighting inequities in the quality of care delivered to Medicare beneficiaries nationwide. Until now, these reports have focused on comparisons within a single year. This new report analyzes historical trends in inequities by race, ethnicity, sex, and geography among Medicare beneficiaries enrolled in Medicare Advantage (MA) plans nationwide.

AARP has released its fourth iteration of the Long-term Services and Supports Scorecard. This scorecard ranks states and DC in order from 1 to 51 on a wide range of issues pertaining to older adults and people with disabilities. The LTSS scorecard has five domains that states are ranked within, and each of those domains has multiple indicators that are used to derive the overall score.

This week, the Senate Finance Committee released the language and summaries of legislation to help nursing home efforts to stop the spread of COVID-19. The Act would call on nursing homes to ensure that a portion Federal relief funds, made available on or after July 1, for responding to COVID-19 would be used for personal protective equipment (PPE) and COVID-19 testing in long-term care facilities. The Act also has language for expanding resources for elder justice activities.

CMCS has released the FFY 2018 Adult Core Set data. This data set provides information on 23 adult measures voluntarily reported by states. Recently released publications include an overview of 2018 findings, a core set chart pack, a summary of performance on measures, and the 2018 quality measures dataset.