MHHA Quality Measure Calculator - LeadingAge Minnesota



MHHA Quality Measure Calculator

General Instructions

Quality Measures:

The MHHA Quality Measure Calculator was developed to assist members in tracking all five of the quality measures that will be used to determine the quality add-on for the 2006 COLA adjustment. The five measures and the maximum points for each are as follows:

|Quality Measure |Maximum Points |Data Reporting Period |

| | |(For 2006 COLA) |

|Quality Indicators |40 |7/1/05 – 3/31/06 |

|Staff Retention |25 |8/1/05 – 1/31/06 |

|Staff Turnover |15 |8/1/05 – 1/31/06 |

|Pool Use |10 |8/1/05 – 1/31/06 |

|MDH Survey |10 |Most recent survey |

|TOTAL |100 | |

COLA Determination:

Facilities with a total quality score of 40 points or below will receive no quality add-on. These facilities will receive only the base COLA of 1.26%. Facilities with a total quality score of 100 points will receive the full 2.4% quality add-on for a total COLA of 3.66%. Facilities with total quality scores between these two points will receive a proportional quality add-on to the base COLA.

How to Use the Calculator:

The calculator is designed to provide a running update of a facility’s score on each of the measures, as well as the total score and the amount of COLA the facility would receive in 2006 with that score. Members can update their turnover, retention, and pool use data monthly to see what level of rate increase they are on track to receive.

Worksheet Instructions:

A yellow cell indicates data that must be inputted by the facility. All cells that are red or clear are automatically calculated and displayed.

Assistance:

For further information or assistance in completing the calculator please contact Jeff Bostic at 651/603-3509 or jbostic@.

MHHA Quality Measure Calculator

Page 1: Staff Turnover & Retention

Worksheet Instructions:

For each job classification listed insert the following:

Column B: The number of employees on 8/1/05

Column C: The number of employees hired since 8/1/05

Column D: The number of employees transferred within your facility and/or organization into that job class since 8/1/05

Column E: The number of employees who have left employment since 8/1/05 and do not qualify for exclusion (see list below)

Column F: The number of employees transferred within your facility and/or organization out of that job class since 8/1/05

Cell B17: The number of months in the data period. Each time you enter data, you should update the number of months, because the turnover and retention percentages are adjusted to reflect what would happen in a year.

Turnover/Retention Scoring:

Staff turnover is computed by the number of direct care employees who left between 8/1 of this year and 1/31 of next year divided by the number of direct care employees. Only terminated employees are counted as turnover, transfers to other job categories or within the same campus are disregarded. Seasonal employees are not counted as turnover if the employee is actively employed during a specified period. A facility will earn 15 points if the annual turnover rate is equal to or less than 20% and will earn zero points if the annual turnover rate is equal to or greater than 70%. Points are distributed on a straight line between those two points. To annualize from six months of data to a full year, the formula is adjusted to double the number of employees who left. By updating the number of months cell on the worksheet, facilities can track their estimated annual turnover percentage on a monthly basis.

The staff retention rate calculation is based on the number of direct care employees on 8/1 of this year that were still employed on 1/31 of next year divided by the number of direct care employees on 8/1. A facility will earn zero points if the annual retention rate is less than 60% and will earn 25 points if the annual retention rate is equal to or greater than 85%. Points are distributed on a straight line between those two points. To annualize from six months of data to a full year, the formula is adjusted to double the number of employees who are not retained. By updating the number of months cell on the worksheet, facilities can track their estimated annual retention percentage on a monthly basis.

Definitions:

Nursing Staff: All nursing staff should be reported in the category according to their licensing or certification status (RN, LPN, CNA, TMA). Nursing administrative staff should be included in the appropriate category if they are a licensed or certified nursing assistant. For example, the DON and MDS coordinators should be reported on the line for Registered Nurses. Other examples of nursing administrative staff may include a Medicare nurse, in-service trainer, scheduler, unit clerks or nursing secretaries, infection control and quality coordinators. If a universal worker is a certified nursing assistant they should be reported on the CNA line. Do not include medical records personnel. If the administrator of the facility is also a licensed RN, they should not be reported as an RN in the employee data section of the report.

Social Services: Includes the social services director, any licensed social workers or unlicensed social worker assistants.

Activities Staff: Includes all activities staff and volunteer coordinators.

Mental Health Workers: Includes psychologists and other trained mental health workers that are employed by the facility. Contract or consulting psychiatrists, etc. are to be excluded.

Other Direct Workers: Other direct care staff includes staff providing direct care to residents. Examples of direct care staff include: feeding assistants, certified occupational therapy assistants and religious personnel. Licensed Physical and Occupation Therapists or their assistants performing billable services (under any benefit set such as Medicare A or B, Private Pay, MA, other private insurer) are not to be included in the turnover and retention statistics. Dietary, housekeeping, laundry, maintenance and administrative staff are not included in the direct care workers category. Van drivers/Transportation staff are to be included as a direct care worker if they are nursing, social service or activities staff and should be reported in those categories. A full time van driver or an employee of a support service category such as maintenance should not be included in the direct care employee data.

Exclusions:

Transferred Employees: Employees transferring between job categories within the facility, or the same company, will not be included in the turnover and retention statistics. If the company still employs an individual but just in a different job category or setting, the job change should be reported as a transfer in or out. In determining the number of staff who were employed for the entire reporting period for each job category, do not include employees who transferred from listed categories to job categories other than those listed. For example, a certified nursing assistant that transferred to a dietary position would not be counted as a direct care worker retained for the reporting period. Do include employees that transfer within these job categories. For example, a LPN that transferred to an RN position should be counted as an LPN retained for the reporting period. An employee transferring to another job category listed and still employed at the end of the report year, should be counted in the category where they started the report year.

Seasonal Employees: A seasonal employee should be counted as an active employee if they are working at the end of the reporting period or it is anticipated they will be working in the next 10 months or 300 days.

On-Call Employees: On-call employees are not to be included in the employee data. An on-call employee provides temporary services for the nursing facility and the nursing facility includes the employee on their payroll system. An on-call employee is not regularly scheduled at any time during the reporting period. If an employee who was a regularly scheduled employee during the reporting period and leaves active employment status during the reporting period but agrees to continue a working relationship with the facility as an on-call employee, that person is to be reported as a employee leaving during the reporting period. If an on-call employee becomes a regularly scheduled active employee, they should be reported as an employee hired.

Probationary Employees: Employees terminated within 90 days from their hire date, may be excluded from the employee data page. These employees should not be reported as either hired or leaving if the 90 period occurs within the reporting period. If the hire date is near the end of the reporting period and the employee is terminated within 90 days of the hire date, but prior to the date the report is filed, this person should be excluded from the employee data page even though the termination occurred following the reporting period. (For example, an employee was hired on January 15, 2006 and terminated on February 15, 2006. The facility files the 1/31/06 cost report on February 28, 2005. This employee should not be included as an employee hired during the reporting period as it is known that the employee was terminated within a 90 day period.) An employee hired prior to the reporting period and terminated within 90 days which occurred after the beginning of the reporting period should not be reported as an employee leaving or included as an employee at the beginning of the report year. (For example, an employee was hired on July 1, 2005 and terminated on September 15, 2005. The report year begins on August 1, 2005. This employee should not be included in the number employed at the beginning of the report year.) *Note – facilities that have a probationary period exceeding 90 days are still restricted to excluding only those terminations that occurred during the first 90 days.

Employees Terminated for Cause: If the facility is required by law to terminate an employee and the cause for termination is supported by official documentation from a regulatory agency, (e.g. Vulnerable Adult Investigation), the termination may be excluded from the employee data.

Scholarship Recipients: Facilities funding scholarships for eligible employees under the Nursing Facility Employee Scholarship Program (MN Statutes, Section 256B.431, subd.36) may be eligible for excluding employees leaving the facility after completing a degree program because the facility did not have a job available in the appropriate job class. For example, a CNA who becomes a licensed LPN and leaves the facility during the reporting period because the facility did not have any open LPN positions at the time the employee became eligible to be hired as an LPN may be excluded from the employee data. To exclude this employee from the data, the facility must have supporting payroll documentation to support that the facility was fully staffed at the time the employee became certified or licensed for an advanced position. An employee voluntarily leaving the facility upon completion of the degree program may not be excluded from the employee data.

Employee Terminations Due to Facility Downsizing: A facility experiencing an increase in turnover as a result of significant downsizing may be eligible for excluding some of the associated employee terminations. If the facility is closing more than 20% of their beds and are negotiating a Planned Closure Rate Adjustment with the Department of Human Services, the facility may pursue negotiating alternative turnover and retention factors with the Department during the negotiations process.

Staff Leaving and Rehired During the Reporting Period: If an employee gives notice and leaves employment from the facility and is later rehired within the reporting period, this employee must be included in the report as an employee leaving and would also be included in the employees hired in the same manner as if they had no previous employment relationship with the facility.

NOTE: The turnover thresholds (20% and 70%) and retention thresholds (85% and 60%) were established by DHS based on the 2003 baseline report data. These thresholds may change depending on the impact of excluded employees on the new data submitted.

MHHA Quality Measure Calculator

Page 2: Pool Use

Worksheet Instructions:

For each job classification listed, indicate the number of pool hours in Column B and the number of total productive hours in Column C.

Pool Use Definitions and Scoring:

Annually, the average percentage of pool hours will be calculated for those facilities reporting any pool use. A facility will earn zero point if their pool use equals or exceeds two times the average. A facility will earn 10 points if pool use is reported at zero. Points are distributed on a straight line between those two points. As pool usage is a percent of total direct hours, no adjustment is required to annualize from six months of data to a full year.

MHHA Quality Measure Calculator

Page 3: MDH Surveys

Worksheet Instructions:

Using your most recent survey, look for deficiencies in any of the 17 F-tags listed. If cited, enter “Yes” in Column B next to the F-tag that was cited, and then enter the scope and severity score for that F-tag in Column C.

MDH Survey Definitions and Scoring:

Seventeen care related deficiencies have been identified as most important in measuring quality of care. A facility will earn 10 points if they do not receive any of those specified deficiencies, or if they do receive deficiencies in these areas but the scope and severity is lower than level F, (no actual harm). A facility will receive 5 points if they received one of the specified deficiencies and it was determined to be at a scope and severity level of F or G, (widespread with potential for more than minimal harm or isolated with actual harm that is not immediate jeopardy). A facility will receive zero points if they receive one of the specified deficiencies at a scope and severity of level H or higher, (pattern or widespread with actual harm or immediate jeopardy to resident health or safety). The specified deficiencies are listed below.

|Deficiencies |

|F-221: Physical Restraints |

|F-222: Chemical Restraints |

|F-223: Abuse |

|F-241: Dignity |

|F-242: Choice of activities & schedules |

|F-310: ADLs |

|F-311: Maintain or improve physical abilities |

|F-314: Pressure sores |

|F-315: Catheters |

|F-316: Bladder treatment |

|F-321: NG tubes |

|F-325: Nutrition |

|F-327: Hydration |

|F-329: Drug prescribing |

|F-330: Antipsychotic use |

|F-332: Medication errors |

|F-353: Sufficient staff |

MHHA Quality Measure Calculator

Page 4: Quality Score Summary/Estimated 2006 COLA

Worksheet Instructions:

Insert your Quality Indicator score from the DHS workbook located at . (Click on “MN Nursing Facility Rates for Risk Adjusted Quality Indicators” go to the fourth tab labeled “QI Points by Domain” and locate your facility specific provider identification number. Your total QI score that should be inserted in the calculator is found in column AB.)

The workbook currently contains QI data from January 1, 2004, through September 30, 2004. The most recent risk-adjusted QI data from the four quarters ending June 30, 2005, will be available from DHS on October 1.

NOTE: MHHA will send all members a summary of their updated, facility-specific QI data through 6/30/05 once it is available. MHHA’s concise summary will include individual facility QI’s by domain, high/low thresholds, facility specific QI scores and total QI points.

Calculation:

After inserting your QI score, the summary page will automatically calculate your projected score for each of the five quality measures as compared to the maximum points available in each category. Your total QI score is then automatically included in the COLA calculation to identify the estimated 2006 COLA adjustment for your facility.

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