nyshfa advanced training initiative & cost report … 1 nyshfa advanced training initiative...

NYSHFA ADVANCED1

NYSHFA ADVANCED TRAINING INITIATIVE & COST REPORT PREPCOST REPORT PREP

July 30, 2015

Introductions2

Kathie Angelone, Director Shauna Seeley Supervisor Shauna Seeley, Supervisor

Division of EFP Rotenberg, LLP

Agendag

RHCF-4 Cost Report Filing Issues3

RHCF 4 Cost Report Filing Issues 2014 Changes 10:00 Exhibit O 10:05 Exhibit P 10:15 Exhibit Q 10:25

Quality Initiative & the RHCF-4 10:35

Advance Training Initiative 11:00 What, When, How and Why?

2014 RHCF-4 – Revisions Configure Screen

4

Added a “PFI” field Permanent facility identifier

Added a “County” field For data mining purposesg p p

Must be completed before you can proceed with preparation of reportwith preparation of report

PFI can be found at: PFI can be found at: http://nursinghomes.nyhealth.gov/

2014 RHCF-4 – Revisions

Configure Screen5

Configure Screen


Schedule 10B6

Schedule 10B

Schedule meant to aid DOH in its energy initiative

Initially added in the 2013 RHCF-4D t fi ld t l f tt d Date fields not properly formatted

Instructions did not explain its purpose

Revised slightly for 2014 Fixed the date formatting


Schedule 10B7

Schedule 10B


Schedule 10B8

Schedule 10B

Most important data is line 113 :”Estimated Useful Life Most important data is line 113 : Estimated Useful Life of Facility”

RHCF-4 Instructions:

“Column 1184: Years Left: This is an estimation made by the Facility to the remaining operational life of the facility. This

could be more than 40 years. “

2014 RHCF-4 Schedule O

Quality Measures9

Quality Measures Section 1: Hours Paid for RN’s, LPN’s & Aides

2014 RHCF-4 Schedule O

Quality Measures10

Quality Measures Section 2: #of employees per quarter and # of

employees terminatedemployees terminated

2014 RHCF-4 Exhibit O

Contract Staff Hours Paid and Terminations11

Contract Staff Hours Paid and Terminations DOH’s methodology based on study results which

indicate that staff retention contributes to higher gquality care.

Very difficult to get accurate info for Schedule O

“Terminations” isn’t really accurate when reporting contract staff

2014 RHCF-4 Exhibit O12

2014 & 2015 Quality measure:

If percentage of contracted staff is <10% you get the 5 points in your quality score. 10% or more p y q yand you get 0.

2014 RHCF-4 – Schedule PStaff Turnover

13

One schedule each for RHCF, Head Injury, Vent & Behavioral

2014 RHCF-4 – Schedule P14

Very Important Schedule

Quality Initiative

Advanced Training Initiative

2014 RHCF-4 – Schedule P15

Staffing Rate Nurse Hours per day for RN’s LPN’s & Aides Nurse Hours per day for RN s, LPN s & Aides

Turnover Rate Turnover Rate Contract and Per Diem staff are excluded from

this measurethis measure.

2014 RHCF-4 – Schedule P

Things to Look For:16

g Col 0770: # Empl on 1/1/2014 Should equal your ending employees on 12/31/2013

Col 0771 - 0774: # Empl on 3/31, 6/30 & 12/31 Col 0771 0774: # Empl on 3/31, 6/30 & 12/31 These columns are at the end of the calendar quarters

Col 0775 & 0776: # FT and PT Empl As of 12/31/2014 As of 12/31/2014

Col 0777: # Empl on 12/31 who were empl on 1/1 **This column cannot be more than col 0770**

Col 0778 & 0779: # Empl Hired and Fired during the Col 0778 & 0779: # Empl Hired and Fired during the year Don’t estimate – get actual data.

2014 RHCF-4 – Schedule P

Issues which can distort the retention and17

Issues which can distort the retention and turnover rates

Long term casual employees – sometimes called “Per Diem”

FMLA – should not count as terminations and/or hires

Transfer departments – how are these employees recorded in your records?

2014 RHCF-4 Exhibit Q18

Not required but strongly recommended!

Currently considered a “reference” document DOH will use it to help with your rate but rate DOH will use it to help with your rate but rate

calculation does not pull from this schedule. Most often used after emails on rate errors Most often used after emails on rate errors.

2014 RHCF-4 Exhibit Q

Capital Streamlining Process19

Capital Streamlining Process September, 2015: Version #1 of capital

component is issued to providers

November, 2015: Version #2 issued with the 2016 draft rates

January (or February), 2016: Version #3 issued with the 2016 Initial rates.

2014 RHCF-4 Exhibit Q

Capital Streamlining Process20

Capital Streamlining Process

Emails can and should be sent to DOH after each Emails can and should be sent to DOH after each version to fix any errors.

DOH will look at Schedule Q during this process

2014 RHCF-4 Exhibit Q21

Give them as much info as possible – Do the work for them! Location of where cost is reported – schedule and

cost center If you need more room put it in the notepad and If you need more room put it in the notepad and

say “SEE NOTEPAD” on Schedule Q If your resident days are < 90% for the year DOH y y y

will impute those days to 90% for use in the capital component.

2014 RHCF-4

QUESTIONS?22

QUESTIONS?

Feel free to contact:Shauna Seeley, RHCCy

w: (585) 295-0548e: [email protected]@ p g

23

Quality Initiative & the RHCF-4

Quality Initiative & the RHCF-4y

Refresher:24

Refresher: Program to reward facilities providing exceptional

quality care and to encourage other facilities to iimprove.

Began in 2013 and continuing through 2015 Currently $50M in project Currently $50M in project $50M is currently in the Medicaid rates and will be

removed and paid to high scorers. No funds have been taken back or paid out 2013 impacts range from $(1.50) to $2.50 per day


Schedule O25

Schedule O

Currently used in 2014 Quality Initiativey Q y

% of Contract/Agency Staff Used RN’s, LPN’s & Aides Only Very difficult to get accurate info for Schedule O

Q lit I iti ti S i Quality Initiative Scoring: < 10% = 5 points >= 10% = 0 points0% 0 po s


Schedule O26

QI Scoring Calculation:S h d l O(1) T t l H P idSchedule O(1) Total Hours Paid

(Sched O hrs Paid + Total Hrs Paid Sched 5A)

Ex: Contract hours paid 3,500 = 2.4%Total hours paid 144,397 < 10%

(RN’s, LPN’s & Aides)

QI Score = 5 PointsQI Score = 5 Points


Quality Measures27

Quality Measures Section 1: Hours Paid for RN’s, LPN’s & Aides

Quality Initiative & the RHCF-4y28

Based on industry feedback and the uncertainty of the reported information newuncertainty of the reported information new staffing measures were considered for 2015.

Two new staffing measures will be gathered Two new staffing measures will be gathered for benchmark purposes but will not be used in scoring. (See Schedule P)g ( )

Contract staff measure will continue to be used for 2015.


Schedule P29

Schedule P

Not yet used in the QI Scoring Not yet used in the QI Scoring

Will be gathered in 2015 (from 2014 RHCF 4) Will be gathered in 2015 (from 2014 RHCF-4) for benchmarking purposes


Schedule P30

Schedule P # of employees at 5 different times during the

yearyear # FT & PT employees at year-end # employees on 12/31 who were employed on # employees on 12/31 who were employed on

1/1 # employees hired during the year # employees hired during the year # employees fired during the year


Schedule P31

Schedule P

Used to calculate both: Used to calculate both:

Staff Retention Staff Retention

Staff Turnover


Schedule P – Staff Turnover32

Schedule P Staff Turnover Proposed QI Calculation:

Data: Data: Total # of RN’s, LPN’s & Aides at end of each quarter

(Schedule P, columns 0771, 0772, 0773, 0774) Total # of RN’s, LPN’s & Aides terminated (Schedule

P, column 0779) Contract and per diem staff are EXCLUDED from this Contract and per diem staff are EXCLUDED from this

measure.Do Not include your per diem (casual) employees on

S h d l PSchedule P.


Schedule P – Staff Turnover33

Schedule P Staff Turnover Proposed QI Calculation:

# Total Annual

Terminations DateRN, LPN, Aide Staff

End Quarter 1 160 Turnover

End Quarter 2 150 Rate

End Quarter 3 155

E d Q t 4 160End Quarter 4 160

24 625

/ 4 / 4

6 Avg Per Qtr 156.25 3.84%

Per DOH NHQI Update


Staff Turnover Rates34

Staff Turnover Rates

Per DOH data – 2013 Staff Turnover rates: Per DOH data 2013 Staff Turnover rates:

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Statewide

3.0% 5.4% 8.4% 12.3% 44.6% 8.4%

Per DOH NHQI Update


Staff Turnover Rates35

Staff Turnover Rates

Other data puts the statewide turnover rate at papproximately 25%.

Turnover rates fairly consistent between sponsors Turnover rates significantly higher upstate than

downstate possibly due to stabilizing influence of unionsunions.

2013 data widely believed to be inaccurate.


NY Annualized Staffing Measure36

NY Annualized Staffing Measure Proposed QI Calculation:

Data: Data: Total # of RN’s, LPN’s & Aides hours worked

(Schedule 5A, columns 0146, 0148, 0150) Hours Expected



NY Annualized Staffing Measure Proposed QI Calculation – Hours Expected

CMS calculation; used in 5 star rating Distribution of RUG categories (closest to survey) Distribution of RUG categories (closest to survey)

X CMS 1995 and 1997 Staff Time Study Rate is per resident dayy



NY Annualized Staffing Measure Proposed QI Calculation:

(Hours worked from Schedule 5A / # ofresidents from MDS) / 365 Daysresidents from MDS) / 365 Days

((RUG distribution from MDS X hours from CMS time study) / #of residents from MDS 3 0)CMS time study) / #of residents from MDS 3.0)

/ 365 days

Per DOH NHQI Update



NY Annualized Staffing Measure National Average April,2014 = 4.03 per

resident per dayresident per day NYS statewide average April, 2014 = 3.9

per resident per dayper resident per day NYS statewide average 2013 = 3.47 per

resident per day (using cost reports)es de pe day (us g cos epo s)

Per DOH NHQI Update


REMEMBER40

REMEMBER

Annualized Staffing measure will not be used to score 2015 QI

Staff Turnover will not be used to score 2015 QI Use this benchmark year to get a handle on

f fwhere your facility falls

Quality Initiative & the RHCF-4y41

Timely filing of the RHCF-4 will get the facility 5 points Late reports get 05 points. Late reports get 0.

RHCF 4 filing deadline is August 14 2015 RHCF-4 filing deadline is August 14, 2015

All tifi ti t b l t b A t All certifications must be complete by August 14, 2015


2015 Change in Scoring42

2015 Change in Scoring Quality Component 2014: 14 measures for possible 70 points Had planned to add Staff Turnover measure with total

possible points of 75; maybe in 2016. Compliance Componentp p 2014: 3 measures for possible 20 points 2015: 3 measures for possible 20 points – had

planned to drop 5 star rating from 10 points to 5 andplanned to drop 5 star rating from 10 points to 5 and total compliance points from 20 to 15; maybe in 2016

Efficiency Component 2014 & 2015: 1 measures for possible 10 points

43

Advanced TrainingAdvanced Training InitiativeInitiative

Advanced Training Initiativeg44

What? What?

NYS reimbursement for training programs aimed NYS reimbursement for training programs aimed at early detection of resident decline.

NYS will provide $46 M in reimbursement for approved programs.


Objectives Objectives

Reduce expensive avoidable hospitalizations for Reduce expensive avoidable hospitalizations for nursing home residents.

Improve quality of life - consistent staff assignment in an effort to ensure families and

id t l hi hl t i d i tresidents can rely on highly trained caregivers to provide effective, high quality, individualized care.


What would training look like? What would training look like?

Help direct care staff identify changes in a Help direct care staff identify changes in a resident’s physical, mental or functional status that could lead to hospitalization.

Development and implementation would be di t d ith DOHcoordinated with DOH.


Eligibility? Eligibility? A facility will be required to fulfill eligibility criteria

before applying for fundspp y g Criteria has not yet been developed Discussions in workgroup around staff retention

rates as criteria – meeting a statewide or regional target (Schedule P!!!)VAP i i t t li ibl VAP recipients are not eligible


Timing Timing

Effective June 1, 2015 Effective June 1, 2015

Workgroup developing eligibility criteria and g p p g g yapproved program guidelines

Hoping to make awards by December, 2015


Application Application Trying to avoid it being too cumbersome Provider Information Provider Information Name, Date, OpCert, Contact

Training Program Details Program, curriculum, # of training hours, who will

participate St ff R t ti & A i t Staff Retention & AssignmentMethods to increase retention, how will retention be

measured


Questions? Questions? Eligibility criteria – regional or statewide? Will DOH approval of acceptable training Will DOH approval of acceptable training

curriculum/programs happen before or after applications are submitted?

How staff retention rate will be calculated –Schedule P – divide col 0777 (employees retained) by col 0774 (employees at 12/31) or byretained) by col 0774 (employees at 12/31) or by col 0770 (employees at 1/1)


Questions? Questions?

May be additional funds available in year 2. May be additional funds available in year 2. Will funds be available for replacing staff while

they are at training? How will the effectiveness of the training be

measured or are there plans for measurement? Payment method


QUESTIONS?QUESTIONS?

Feel free to contact:Kathie Angelone RHCCKathie Angelone, RHCC

w: (585) 295-0570e: [email protected]

nyshfa advanced training initiative & cost report … 1 nyshfa advanced training initiative...

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