BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

TMF Networks has posted 2 Claims-Based QM Tip Sheets:

• Percentage of Short-Stay Residents Who Have Had an Outpatient Emergency Department Visit

This claims-based measure tip sheet provides an overview of the measure, including questions to ask, monitoring ideas and resource links.

This measure reports the percentage of short-stay residents who had an outpatient Emergency Department (ED) visit after a nursing home admission (i.e., an ED visit not resulting in an inpatient hospital admission) within 30 days of entry or reentry to the nursing home).

• This measure is included in the Five-Star Rating System.                                                                    
• Lower values indicate higher performance in this measure.                                                               
• Medicare Part B claims are used to identify outpatient ED visits. Medicare Part A and Part B are used to identify inpatient and observation stays.

• Number of Outpatient Emergency Department Visits per 1000 Resident Days 

This claims-based measure tip sheet provides an overview of the measure, including questions to ask, monitoring ideas and resource links.

This measure determines the number of outpatient ED visits that occurred among long stay residents of a nursing home during a one-year period, expressed as the percent of ED visits for every 1,000 days that long-term residents were admitted to the nursing home.

• This measure is included in the Five-Star Rating System.                                                                    
• Lower values indicate higher performance in this measure

Both Tip Sheets contain a wealth of information about each of these claims-based QMs including additional resources. Each is 2-pages in length.