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Date ArticleType
11/2/2016 Payment/Reimbursement
Indiana Medicaid Value Based Purchasing

Discussions on improving the Indiana Medicaid Nursing Facility Value Based Purchasing methodology formally kicked off in late September and the latest meeting took place on October 28th.  Representing the IHCA at the meeting were Mary Pankey, Director of Clinical Operations for CarDon & Associates, and Zach Cattell, IHCA President. 

The discussion focused on determining broad domains under which sub-groups would form to hash out proposals to bring back to the larger group for consideration, to determine the weighting and scoring methodology, and review modeling.  The domains that were discussed at the meeting were Clinical Care, Regulatory Compliance, Staffing, and Resident Preference.  The following are some highlights of the discussion within those domains:

Clinical Care:  Using the Long Stay Quality Measures that are used in the CMS Five Star system, perhaps with particular focus on the measures that there is greater room for improvement.  Focus on a composite score, rather than just picking individual measures appeared to be preferred.  Hospital admissions for long stay residents was also discussed, and data from the MDS could be used to develop this measure much like is done with facilities that are part of the OPTIMISTIC program.
Regulatory Compliance:  Continued focus on the ISDH Report Card Score was the focus of the discussion.  The ISDH has not yet presented new data for their proposed new methodology, but we expect that to come soon.  This was the least discussed domain as there was wide agreement to continue the use of the Report Card Score.
Staffing:  Probably the most discussed domain during the meeting on Oct. 28th.  The shortages of staffing across the state make it very hard to incentivize performance based on retention and turnover.  That said, there were many in the room that agreed that better retention of staff can lead to better quality of care and quality of life.  There was more discussion on incentivizing certain educational advancement and training opportunities through requirements for dementia, infection control, and respiratory care certifications.
Resident Preference:  The discussion primarily focused on whether or not satisfaction surveys should be incentivized through a VBP program, and the pros and cons to doing so.  Other ideas regarding incentivizing focus on Advance Care Planning or other resident-centered activities were discussed.  This ended up in a broader discussion about using one or two broader process measures, rather than outcomes measures, that capture resident preferences.

After the discussion of the above four domains, it was decided that two subgroups would be formed.  One will address the Clinical Care domain, which Mary Pankey will help lead.  The other subgroup will explore process measures with an eye towards resident preferences.  No subgroup was deemed necessary for the Regulatory Compliance domain until ISDH produces a new run of data on the revised Report Card Score methodology.  Additionally, no group will form regarding staffing measures at this time.

The next meeting of the VBP group is November 18th at which times the two subgroups will meet to discuss their assignments.