QAPI Relay Residents Who Self-Report Moderate to Severe Pain Long-Stay Quality Measure Coding Improvements

Transcription

1 QAPI Relay Residents Who Self-Report Moderate to Severe Pain Long-Stay Quality Measure Coding Improvements Stacy Gordon, RN, MS, RAC-CT Senior Quality Improvement Facilitator May

2 Today s Call is Provided by Telligen Telligen: The Medicare Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) for Colorado, Iowa and Illinois QIN-QIO Program Purpose: To improve the efficiency, effectiveness, economy, and quality of services delivered to Medicare beneficiaries 2

3 Disclaimer The MDS information included in this presentation was current at the time of publication to our website (May 2018). Medicare policy changes frequently so links to the source documents are included near the end of this presentation for your reference. This presentation may contain references or links to statutes, regulations or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. Readers are encouraged to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 3

4 Objectives Review the pain long-stay quality measure Describe how to code pain in Section J on the MDS Discuss the MDS items that trigger the quality measure Review how to reduce this quality measure through coding improvements 4

5 Percent of Long-Stay Residents Who Self-Report Moderate to Severe Pain Reported on your CASPER Used in the Five-Star Quality Rating System Target assessment reason for assessment 5

6 Rationale for Quality Measure (QM) Association with inactivity, depression, and functional decline Pain can interfere with rehabilitation Recognition of pain important for effective pain management Care plan development 6

7 Coding Pain J0100 A-C Section J Health Conditions Review the medical record and interview staff J0100A Received pain medication J0100B Received PRN OR offered and declined J0100C Received non-medication intervention 7

8 Coding Pain J0200 J0200 Should pain assessment interview be conducted? Importance of pain information directly from the resident Interview allows the resident s voice to be reflected in the care plan 8

9 Coding Pain Pain Assessment Interview Section J Interview any resident residents that you coded yes for in section J day look-back period Have you had pain or hurting at any time in the last 5 days? 9

10 Coding Pain J0400 J Frequency How much of the time have you experienced pain or hurting over the last 5 days? No predetermined definitions Use of standardized tool 10

11 Coding Pain J0500 J0500 Pain effect on function Over the past 5 days, has pain made it hard for you to sleep at night? Over the past 5 days, have you limited your day-today activities because of pain? 11

12 Coding Pain J0600 J0600 Pain intensity Numeric Rating Scale or Verbal Descriptor Scale Numeric Please rate your worst pain. Verbal Please rate the intensity Use of visual cue card showing 0-10 or verbal scale 12

13 Coding Pain J0700 J0700 Should the staff assessment for pain be conducted? This closes the pain interview Determines if the resident interview was complete or incomplete 13

14 Coding Pain J0800 J0800 Indicators of Pain (staff assessment) Review the medical record Interview staff Observe the resident 14

15 Coding Pain J0850 J0850 Frequency of Indicator of Pain Review the medical record Interview staff Observe the resident 15

16 What will Trigger this Quality Measure? 16

17 Quality Measure Calculation Numerator Long-stay residents with a selected target assessment with either or both of the following: Condition #1: report almost constant or frequent moderate to severe pain (J0400=1,2) AND at least one episode of moderate to severe pain (J0600A=5,6,7,8,9 or J0600B=2,3) Condition #2: report very severe/horrible pain of any frequency (J0600A=10 or J0600B=4) Denominator All long stay residents with a selected target assessment, except those with exclusions. 17

18 Exclusions Admission assessment, PPS 5-day assessment, or a PPS readmission/return assessment The resident did not meet the pain symptom conditions for the numerator: Pain assessment interview not completed Pain presence item not completed Any of the following occurred in the last 5 days: Pain frequency not completed (J0400=9,-) Neither of the pain intensity items were completed (J0600A=99,- and J0600B=9,-) The numeric pain intensity item indicates no pain (J0600A=0) 18

19 Covariates A set of resident clinical characteristics that adjust for potential differences in residents between facilities and thereby level the playing field. Levels the playing field for facilities with unique resident demographics Independence or modified independence in daily decision making on the prior assessment 19

20 Can I Improve this Quality Measure? 20

21 CASPER Facility Level 21

22 CASPER Resident Level 22

23 Coding and Care Tips Know your RAI manual Behavior change may be related to pain Consistent approach Assess for pain during care Have a process for documentation of pain especially when a prn pain med is offered and declined Assess aggravating and alleviating factors Information gained from resident interview when interview incomplete 23

24 QAPI Opportunity Charter a PIP Determine how many residents you want to reduce by on the CASPER reports SMART goal 5 whys PDSA Sustain 24

25 Questions THANK YOU FOR YOUR ATTENDANCE AND PARTICPATION 25

26 Resources MDS 3.0 Quality Measures User s Manual effective Instruments/NursingHomeQualityInits/Downloads/MDS-30-QM-Users- Manual-V11-Final.pdf RAI MANUAL pdf TELLIGEN QIN-QIO NATIONAL NURSING HOME QUALITY CARE COLLABORATIVE CHANGE PACKAGE pdf 26

27 Receive the Weekly Digest! ed every Monday Latest events, news and resources from Telligen and our partners Visit to sign up! 27

28 Please Contact any of our Quality Innovation Network Representatives to Learn More Lisa Bridwell Nell Griffin Stacy Gordon Gina Anderson Elizabeth Schulte Deanna Curry Kristen Ives NHSN support Sarah Wendelboe NHSN support This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-C2-05/03/