Skilled Nursing Goals

​​​​​​The AHCA Quality Initiative is a national, multi-year effort to further improve quality of care in America’s long term and post-acute care centers. Since the launch of the Initiative in 2012, members have been challenged to meet measurable targets in key areas such as hospitalizations and antipsychotics usage. While significant improvements have been made, more must be done. The next phase of the effort continues to challenge providers to achieve quantitative results in four areas by March 2021. These areas are top priorities for the Centers for Medicare & Medicaid Services (CMS), Accountable Care Organizations (ACOs) as well as Managed Care Organizations (MCOs), and are aligned with federal mandates that link financial outcomes to quality performance.

 Hospitalizations

Goal: Safely reduce long-stay and short-stay hospitalizations by improving 10 percent (Q1 2017 baseline rates)—or maintain a rate of 10 percent or less—by March 2021.

Hospital readmissions not only have the potential for negative physical, emotional, and psychological impacts on individuals in skilled nursing care, but also cost the Medicare program billions of dollars.

Preventing these events whenever possible is always beneficial to residents and has been identified by policymakers and providers as an opportunity to reduce overall health care system costs through improvements in quality. The issue is a top priority for the Centers for Medicare & Medicaid Services (CMS) and managed care programs. An example of this is the Skilled Nursing Facility (SNF) Value Based Purchasing (VBP) Program, a CMS effort that links financial outcomes to quality performance that starts on October 1, 2018.

 Resources

 Progress

​ Progress will continue to be measured by using two National Quality Forum (NQF)-endorsed measures--PointRight® Pro 30™ and PointRight® Pro Long Stay™--available in AHCA’s members-only data collection and benchmarking tool, LTC Trend Tracker

 Customer Satisfaction

​​Goal: Improve long-stay and short-stay satisfaction by 10 percent (Q1 2017 baseline rates)—or achieve a rate of > 90 percent—by March 2021.

​Similar to many other professions, the happiness and peace of mind of residents and their families is paramount to skilled nursing care centers. That is why the Association has made great progress in identifying a customer satisfaction survey—CoreQ—that can be uniformly used by long term and post-acute care providers. 

CoreQ
The profession lacked a national data source that would allow the measurement of satisfaction across all long term and post-acute care providers. AHCA/NCAL developed a core set of customer satisfaction questions to address that challenge. The CoreQ—consisting of three questions for long-stay residents/family members and four for short-stay—has been independently tested as a valid and reliable measure of customer satisfaction. To learn more about the CoreQ, please visit the CoreQ website.

 Resources

 Progress

​Progress will be measured by using a core set of customer satisfaction questions that can be uniformly used by long term and post-acute care providers. The NQF endorsed the questionnaire called "CoreQ" which has been independently tested as a valid and reliable measure.  AHCA members will continue to upload and track their data using LTC Trend Tracker.

 Functional Outcomes

Goal: Improve functional outcomes (self-care and mobility) by 15 percent (Q1 2017 baseline rates) by March 2021.

Skilled nursing care providers improve the lives of the residents they care for in a number of ways, including improving their functional outcomes and independence.

The Medicare Payment Advisory Commission (MedPAC), the IMPACT Act, and CMS all called for the development of functional improvement measures based on the self-care and mobility sections of the Continuity Assessment Record and Evaluation (CARE) tool. Maintaining or improving mobility and self-care abilities is important to healthy aging and maximizing independence.

 Resources

 Progress

​Progress is measured using two NQF-endorsed measures developed by AHCA in LTC Trend Tracker

 Antipsychotics

Goal: Safely reduce the off-label use of antipsychotics by 10 percent (Q1 2017 baseline rates)—or maintain a rate of 8 percent or less in long-stay residents, and maintain a rate of 1 percent or less in short-stay residents—by March 2021.

A large number of the individuals in skilled nursing centers are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior. The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia.

Antipsychotic drugs are expensive, costing hundreds of millions of Medicare dollars. They also increase the risk of death, falls with fractures, hospitalizations and other complications resulting in poor health and high costs.

The intent of the AHCA Quality Initiative goal to safely reduce the off-label use of antipsychotics is to encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications and to ensure that antipsychotic medications, when used, are as appropriate and safe as possible.

 Resources


​DISCLAIMER: The AHCA/NCAL quality programs’ contents, including their goals and standards, represent some preferred practices, but do not represent minimum standards or expected norms for skilled nursing and/or assisted living providers. As always, the provider is responsible for making clinical decisions and providing care that is best for each individual person.