The landscape of healthcare quality reporting is constantly evolving, especially within acute care settings. Understanding the measures that drive quality improvement is crucial for hospitals aiming for excellence in patient care and regulatory compliance. This guide delves into the critical aspects of acute care hospital quality improvement programs, specifically focusing on the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) measures for Fiscal Year (FY) 2027. While our focus is on the FY 2027 framework, the foundational measures and reporting mechanisms discussed here are essential for any healthcare professional involved in quality improvement within the hospital ecosystem.
The LTCH Quality Reporting Program (QRP) plays a vital role in ensuring high-quality care in long-term care hospitals. This program mandates that LTCHs report specific quality measures to the Centers for Medicare & Medicaid Services (CMS). These measures are designed to assess various aspects of patient care, from preventing falls and infections to improving functional outcomes and ensuring proper care transitions. Data collected through the LTCH QRP not only helps CMS monitor the quality of care provided in LTCHs but also informs payment updates and incentivizes continuous improvement.
LTCH QRP measures utilize various data collection methods to ensure a comprehensive and accurate assessment of hospital performance. These methods include:
LCDS Assessment-Based Measures: Leveraging the LTCH CARE Data Set
A significant portion of LTCH QRP measures relies on data collected through the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS). This standardized assessment tool is crucial for capturing patient-level data, which is then submitted to CMS via the Internet Quality Improvement and Evaluation System (iQIES). Here are the LCDS assessment-based measures currently in place:
LTCH QRP Measure #1: Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay)
This measure, endorsed by the consensus-based entity (CBE), focuses on patient safety by tracking the percentage of long-stay residents who experience one or more falls resulting in major injuries. Initially finalized in the FY 2014 Inpatient Prospective Payment System (IPPS)/LTCH Prospective Payment System (PPS) Final Rule, this measure underscores the importance of fall prevention programs within LTCHs. Data collection began on April 1, 2016.
LTCH QRP Measure #2: Functional Outcome Measure: Change in Mobility Among Long-Term Care Hospital Patients Requiring Ventilator Support
Another CBE-endorsed measure, this assesses the change in mobility for LTCH patients who require ventilator support. Finalized in the FY 2015 IPPS/LTCH PPS Final Rule, this measure highlights the focus on functional outcomes and rehabilitation in LTCH settings, especially for patients with complex needs. Data collection commenced on April 1, 2016.
LTCH QRP Measure #3: Drug Regimen Review Conducted with Follow-Up for Identified Issues – Post-Acute Care (PAC) Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)
This measure, while not CBE-endorsed, emphasizes medication safety and management within LTCHs. It tracks whether drug regimen reviews are conducted and if identified issues are appropriately followed up on for post-acute care patients in LTCHs. Finalized in the FY 2017 IPPS/LTCH PPS Final Rule, data collection for this measure began on July 1, 2018.
LTCH QRP Measure #4: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
Focusing on preventing hospital-acquired conditions, this measure monitors changes in skin integrity, specifically pressure ulcers or injuries, in post-acute care settings. This measure, not CBE-endorsed, replaced a previous measure related to pressure ulcers and was finalized in the FY 2018 IPPS/LTCH PPS Final Rule. Data collection started on July 1, 2018.
LTCH QRP Measure #5: Compliance with Spontaneous Breathing Trial (SBT) by Day 2 of the LTCH Stay
This measure assesses adherence to best practices in ventilator management by tracking compliance with Spontaneous Breathing Trials (SBT) for patients on ventilators. Not CBE-endorsed, it was finalized in the FY 2018 IPPS/LTCH PPS Final Rule, with data collection starting on July 1, 2018.
LTCH QRP Measure #6: Ventilator Liberation Rate
Complementing the previous measure, the Ventilator Liberation Rate measures the success of weaning patients off ventilators in LTCHs. This measure, not CBE-endorsed, was also finalized in the FY 2018 IPPS/LTCH PPS Final Rule and began data collection on July 1, 2018.
LTCH QRP Measure #7: Transfer of Health (TOH) Information to the Provider Post-Acute Care (PAC)
Effective care transitions are crucial for patient safety and continuity of care. This measure assesses whether essential health information is transferred to the next provider when a patient is discharged from an LTCH to another post-acute care setting. Not CBE-endorsed, it was finalized in the FY 2020 IPPS/LTCH PPS Final Rule, and data collection began on October 1, 2022.
LTCH QRP Measure #8: Transfer of Health (TOH) Information to the Patient Post-Acute Care (PAC)
Patient engagement and empowerment are key aspects of quality care. This measure focuses on ensuring patients receive their health information upon discharge from an LTCH to a post-acute care setting. Similar to measure #7 and also not CBE-endorsed, it was finalized in the FY 2020 IPPS/LTCH PPS Final Rule, with data collection starting on October 1, 2022.
LTCH QRP Measure #9: Discharge Function Score
This measure, finalized in the FY 2024 IPPS/LTCH PPS Final Rule, focuses on the functional status of patients at discharge. The Discharge Function Score provides a standardized way to assess patient mobility and self-care capabilities upon leaving the LTCH. Data collection for this measure began on October 1, 2023.
LTCH QRP Measure #10: COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date
Reflecting the ongoing importance of infection control and public health, this measure tracks the percentage of patients and residents in LTCHs who are up to date with their COVID-19 vaccinations. Finalized in the FY 2024 IPPS/LTCH PPS Final Rule, data collection will begin on October 1, 2024.
For comprehensive details regarding data collection and submission deadlines for these LCDS-based measures, refer to the LTCH Quality Reporting Data Submission Deadlines webpage. Additional information on data sets and guidance can be found in the LCDS Manual, particularly Chapter 3, available on the LTCH CARE Data Set (LCDS) & LCDS Manual webpage.
CDC NHSN Measures: Utilizing the National Healthcare Safety Network
Another critical data collection method for LTCH QRP measures is the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). NHSN is a web-based surveillance system widely used in healthcare settings to track infections and other adverse events. LTCHs submit data for the following measures via NHSN:
LTCH QRP Measure #11: National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure
This CBE-endorsed measure focuses on preventing catheter-associated urinary tract infections (CAUTIs), a common healthcare-associated infection. Finalized in the FY 2013 IPPS/LTCH PPS Final Rule, data submission for this measure began on October 1, 2012.
LTCH QRP Measure #12: National Healthcare Safety Network (NHSN) Central Line-Associated Bloodstream Infection (CLABSI) Outcome Measure
Similar to CAUTI, Central Line-Associated Bloodstream Infections (CLABSIs) are serious healthcare-associated infections. This CBE-endorsed measure tracks CLABSI rates in LTCHs. Also finalized in the FY 2013 IPPS/LTCH PPS Final Rule, data submission commenced on October 1, 2012.
LTCH QRP Measure #13: National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure
Clostridium difficile infection (CDI) is another significant healthcare-associated infection. This CBE-endorsed measure monitors facility-wide, hospital-onset CDI rates in LTCHs. Finalized in the FY 2014 IPPS/LTCH PPS Final Rule, data submission began on January 1, 2015.
LTCH QRP Measure #14: Influenza Vaccination Coverage Among Healthcare Personnel
Protecting healthcare personnel from influenza is crucial for both their well-being and patient safety. This CBE-endorsed measure tracks influenza vaccination coverage among healthcare personnel in LTCHs. Finalized in the FY 2013 IPPS/LTCH PPS Final Rule, data submission for this measure started on October 1, 2014.
LTCH QRP Measure #15: COVID-19 Vaccination Coverage among Healthcare Personnel (HCP)
Expanding on vaccination coverage, this measure specifically tracks COVID-19 vaccination coverage among healthcare personnel. While not CBE-endorsed, it reflects the critical importance of COVID-19 vaccination in healthcare settings. Finalized in the FY 2022 IPPS/LTCH PPS Final Rule and modified in the FY 2024 IPPS/LTCH PPS Final Rule, data submission began on October 1, 2021, with modified data collection starting October 1, 2023.
Medicare Fee-For-Service Claims-Based Measures: Leveraging Existing Data
The LTCH QRP also utilizes Medicare Fee-For-Service claims data to calculate certain quality measures. This approach minimizes the reporting burden on LTCHs as it leverages data already submitted for payment purposes.
LTCH QRP Measure #16: Discharge to Community – Post-Acute Care (PAC) Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)
This CBE-endorsed measure assesses the success of LTCHs in discharging patients back to the community after post-acute care. It reflects the goal of helping patients return to their homes and maintain independent living. Finalized in the FY 2017 IPPS/LTCH PPS Final Rule, data for this measure began with CY 2016 claims data.
LTCH QRP Measure #17: Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)
Focusing on cost-effectiveness, this CBE-endorsed measure tracks Medicare spending per beneficiary during a post-acute care episode in an LTCH. It aims to promote efficient resource utilization while maintaining quality of care. Finalized in the FY 2017 IPPS/LTCH PPS Final Rule, data for this measure also began with CY 2016 claims data.
LTCH QRP Measure #18: Potentially Preventable 30-Days Post-Discharge Readmission Measure for Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)
This measure, not CBE-endorsed, focuses on preventing unnecessary hospital readmissions. It tracks potentially preventable readmissions within 30 days of discharge from an LTCH. Finalized in the FY 2017 IPPS/LTCH PPS Final Rule, data for this measure began with CY 2016 claims data.
Measures Removed from LTCH QRP: Adaptation and Evolution
The LTCH QRP is a dynamic program that evolves over time to ensure the measures remain relevant and effective. Several measures have been removed from the program, often due to redundancy, replacement with more robust measures, or achieving widespread adoption of best practices. These removed measures include:
- Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Replaced by Measure #4)
- Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay)
- National Healthcare Safety Network (NHSN) Facility-Wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus aureus Bacteremia Outcome Measure
- National Healthcare Safety Network (NHSN) Ventilator-Associated Event (VAE) Outcome Measure
- All-Cause Unplanned Readmission Measure for 30 Days Post-Discharge from Long-Term Care Hospitals
- Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
- Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
Updates to LTCH QRP: Staying Current with Program Changes
The LTCH QRP regularly updates its guidelines and specifications. Recent updates include:
September 3, 2024: Updates to data elements used for reporting assessment-based Quality Measures (QMs) and Standardized Patient Assessment Data Elements affecting the FY 2027 Annual Payment Update (APU) determination. The FY 2027 LTCH QRP APU Table is available in the Downloads section of the program webpage.
August 30, 2024: Release of the LTCH QRP Quality Measure Calculations and Reporting User’s Manual V6.0, along with a Change Table, Risk Adjustment Appendix File, and Imputation Appendix File. These documents provide updated specifications for calculating quality measures and are effective October 1, 2024. They can be accessed in the Downloads section of the program webpage.
Staying informed about these updates is crucial for LTCHs to ensure accurate data submission and compliance with the LTCH QRP. For archived information, please visit the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) Archives.
Conclusion: Driving Quality Improvement in Acute and Long-Term Care
The LTCH QRP measures are integral to driving quality improvement within long-term care hospitals and contribute to the broader landscape of acute care hospital quality initiatives. By focusing on patient safety, functional outcomes, infection prevention, and efficient care transitions, these measures provide a framework for LTCHs to enhance the care they provide. Understanding and actively participating in the LTCH QRP is not just a matter of regulatory compliance; it’s a commitment to providing the highest quality care to patients in the post-acute care setting and contributing to overall improvements in the healthcare system. As we look towards FY 2027, continued focus on these measures will be essential for advancing acute care hospital quality improvement programs and ensuring optimal patient outcomes.
