RUG and QM Reports Update

Presented to State Veterans’ Homes AdministratorsPresented by Janet Barber

National Program Manager, Data Mgmt. and AnalyticsGeriatrics and Extended Care Operations

Department of Veterans Affairs

RAI/MDS

Resident Assessment Instrument/ Minimum Data Set

RAI/MDS was designed to facilitate achievement and maintenance of the resident’s highest practical level of well-being by identifying and documenting individual resident’s needs and strengths, and incorporating this information into the resident’s care plan

RUG REPORTS

What is a RUG?

Resource Utilization Group This classification system uses information

from the MDS assessment to classify nursing home residents into a series of groups representing the residents’ relative direct care resource requirements

RUG Basics1

SVH reports will utilize RUG IV There are 66 RUGs in the RUG IV

classification system

RUG Basics2

Eight major classification categories Rehab plus Extensive Services Rehabilitation Extensive Services Special Care High Special Care Low Clinically Complex Behavioral Symptoms & Cognitive Performance Reduced Physical Function

RUG report

Facility: Any SVH

 

Date Range:01-OCT-13 to 31-OCT-13

Creation Date:07-JAN-14

 

Average CMI Weight: 9.93 (Total CMI Weight / Total Assessments)

Total Assessments: 171

Total CMI Weight: 1698.0

 

Number of assessments in this reporting month that were completed late.

This is a count of late assessments for the reporting month,

and may not have been used for the RUGS counts.

Quarterlies : 0

Fulls : 0

Total : 0

RUG Model/Logic Version: 66/103

RUG Weight Set: MEDICARE RUGS Model 66 RURAL-FY2012

Reference: MDS 3.0 Users Manual

DOMAIN Assmt #Assmts with CMI Weight CMI Wt.

SubDomain RUG (ADL Range) ADL this RUG & ADL this RUG Sub-Total

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1. REHAB PLUS EXTENSIVE SERVICES

ULTRA HIGH INTENSITY

RUX (11-16) - - 66.0 0.0

RUL (2-10) - - 65.0 0.0

VERY HIGH INTENSITY

RVX (11-16) - - 64.0 0.0

RVL (2-10) - - 62.0 0.0

HIGH INTENSITY

RHX (11-16) - - 63.0 0.0

RHL (2-10) - - 57.0 0.0

MEDIUM INTENSITY

RMX (11-16) - - 58.0 0.0

RML (2-10) - - 55.0 0.0

LOW INTENSITY

RLX (2-16) - - 52.0 0.0

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Category SubTotal 0 0.0

CMI

Each RUG group has a weighted value called Case Mix Index

Represents the relative use of resources for a resident

Case refers to nursing facility resident Mix refers to the mixture of different types

of residents cared for in the CLC

Things to consider1

How do your residents fall into the various RUG categories?

Would first pay attention to the residents in the Reduced Physical Function and the Behavioral Symptoms & Cognitive Performance categories These residents may be served better in a different

level of care They may be ready for assistive living or admission into your

domiciliary They may be ready for discharge home with home health

services

Things to consider2

You can determine the residents’ discharge goal by the coding in Section Q

QM REPORTS

What is a QM?

Quality Measure One method for determining the quality of

care in a nursing home is through the use of Quality Measures

What is a QM2

Quality Measures are derived from resident assessment data (RAI/MDS) routinely collected on the residents at specified intervals during their stay

Measures are valid and reliable - based on the best research currently available

What is a QM3?

Measures are not intended to be benchmarks, thresholds, guidelines, or standards of care Rather,

They are markers for facility trending and comparison

Allows facilities to monitor progress over time They are pointers to potential problem areas/areas

of possible weakness

The SVHs will be receiving from the VA the Annual survey process report (also called Surveyors Report). It contains all of the quality measures plus the addition of 4 immunization measures.

Short Stay vs. Long Stay

Short Stay Quality Measures: Include all residents in an episode whose

cumulative days in the facility is less than or equal to 100 days at the end of the target period

Long Stay Quality Measures: Include all residents in an episode whose

cumulative days in the facility is greater than or equal to 101 days at the end of the target period

Short Stay Measures

Percent of Residents who Self-Report Moderate to Severe Pain

Percent of Residents with Pressure Ulcers that are New or Worsened

Percent of Short-Stay Residents Who Newly Received an Antipsychotic Medication

Percent of Residents who were Assessed and Appropriately Given the Seasonal Influenza Vaccine

Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine

Long Stay Measures1

Prevalence of Falls Percent of Residents Experiencing One or

More Falls with Major Injury Percent of Residents who Self-Report

Moderate to Severe Pain Percent of High-Risk Residents with Pressure

Ulcers Percent of Long-stay Residents with a Urinary

Tract Infection

Long Stay Measures2

Percent of Low-Risk Residents Who Lose Control of their Bowels or Bladder

Residents Who Have/Had a Catheter Inserted and Left in Their Bladder

Percent of Residents Who Were Physically Restrained

Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased

Long Stay Measures3

Percent of Long-stay Residents Who Lose Too Much Weight

Percent of Residents Who have Depressive Symptoms

Prevalence of Antianxiety/Hypnotic Use Percent of Long-Stay Residents Who Received

An Antipsychotic Medication

Long Stay Measures4

Prevalence of Behavior Symptoms Affecting Others

Percent of Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine

Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine

QM Report

Description MsmtID Num Denom FAC Obs FAC Adj StatAvg VISNAvg NatlAvg NatPctl----------- ------ ---- ------ ------- ------- ------- ------- ------- -------Self-Report Moderate to Severe Pain[S] N001.01 3 20 15.0% - 17.8% 18.0% 22.4% 100.0% With Pressure Ulcers New or Worsened[S] N002.01 38 38 100.0% 100.0% 96.6% 94.1% 90.7% 100.0% Assessd + Appr Givn Seasonal Influenza Vaccine[S] N003.01 15 15 100.0% - 88.5% 92.6% 83.6% 100.0% Assessd + Appr Given the Pneumococcal Vaccine[S] N007.01 40 40 100.0% - 94.4% 92.5% 83.7% 100.0% Shrt Stay Who Newly Received an Antipsych Med[S] N011.01 2 7 28.6% - 17.8% 11.6% 05.5% 100.0% Expr One or More Falls with Major Injury[L] N013.01 8 207 03.9% - 03.7% 03.7% 03.5% 100.0% Self-Report Moderate to Severe Pain[L] N014.01 6 148 04.1% 55.1% 10.8% 10.2% 10.3% 100.0% High-Risk With Pressure Ulcers[L] N015.01 3 109 02.8% - 02.2% 04.8% 06.1% 100.0% Assessd + Appr Givn Seasonl Influenza Vaccine[L] N016.01 203 203 100.0% - 99.2% 99.3% 94.1% 100.0% Assessd + Appr Given Pneumococcal Vaccine[L] N020.01 208 208 100.0% - 98.9% 98.5% 96.1% 100.0% With a Urinary Tract Infection[L] N024.01 8 208 03.8% - 03.7% 05.3% 05.3% 100.0% Low Risk Who Lose Control of Bowel or Bladder[L] N025.01 1 2 50.0% - 50.5% 55.4% 59.5% 100.0% Have/Had a Catheter Insertd + Left in Bladder[L] N026.01 1 171 00.6% 52.8% 04.0% 04.2% 05.3% 100.0% Were Physically Restrained[L] N027.01 0 208 00.0% - 00.0% 00.5% 01.6% 00.0% Need for Help w/ Activities Daily Living Incr[L] N028.01 18 138 13.0% - 12.8% 14.2% 14.7% 100.0% Lose Too Much Weight[L] N029.01 16 208 07.7% - 07.5% 08.2% 07.6% 100.0% Have Depressive Symptoms[L] N030.01 1 187 00.5% - 05.3% 05.6% 04.9% 100.0% Received An Antipsychotic Medication[L] N031.02 70 208 33.7% - 29.5% 30.8% 25.8% 100.0% Had a Fall During their Episode of Care[L] N032.01 131 207 63.3% - 60.2% 58.4% 53.6% 100.0% AntianxietyOrHypntcMed+noEvidPsychotcOrRltdTrgtPrd[L] N033.01 0 75 00.0% - 00.0% 00.0% 00.0% 00.0% Behavr Symptoms Affect Others for Trgt Prd[L] N034.01 28 188 14.9% - 23.9% 26.9% 28.0% 100.0%