overview of data collection elements - Nursing Home Help

OVERVIEW OF DATA COLLECTION ELEMENTS
(pages 1-3; Definitions and ECCP Staffing pages 4-9)
DROPDOWN LISTS (Jessica will maintain, please e-mail updates as they occur so she can insert)
This tab is to record:
1) the names and ID numbers (NPI) of participating facilities in your ECCP along with that facility's Medical
Director and his/her NPI;
2) the names and ID numbers (NPI) of hospitals associated with your ECCP (where residents may be
transferred);
3) the names and ID numbers (NPI) of clinicians who order hospital transfers out of your facilities;
4) the names and ID numbers (NPI) of all primary care physicians who are the PCP of record for your
residents;
5) the names and ID numbers (NPI) of all NPs/PAs who are responsible for the routine care of your residents;
6) any Medicaid Managed Care plans in which your residents could be enrolled; and
7) any Medicare Advantage plans in which your residents could be enrolled.
Ensure that these lists are filled out completely and accurately. They will serve as the drop down lists from which
you will select hospitals, doctors, etc. for the rest of the workbook. This is intentional and we ask that you include
ALL people who belong to each of these categories. These are included to ensure that there is consistency
throughout the tool. This information will carry over from quarter to quarter. After completing these lists initially,
only changes will need to be recorded for future quarters.
RESIDENT ROSTER (Resident Roster Contact (RRC) updates blue, purple, and green columns; APRN
updates the orange and updates for green when these occur)
This tab is used as a roster for all long stay residents within an ECCP. Please complete the roster for all long stay
residents at the facility - not just those who are participating in the intervention. Each resident should be listed
only once unless they are discharged and then readmitted to the facility with a new admission date leading to
long-stay status. This log will serve as the basis for data collection throughout this workbook. Note: We are asking
for a roster of all long stay residents at the participating nursing facilities with the understanding that the nursing
facility may chose not to report on long stay residents who are not eligible for the ECCP intervention.
It is vital to keep an accurate record of all of the long stay residents eligible for the ECCP intervention. The purpose
of this tool is to provide a consistent template to record all long stay residents at your facility. This roster will allow
us to gather useful information on the status of each resident as well as serve as the basis for filling out the
medication and hospital transfer logs later in this data collection tool. Note: We will use the name and admission
date of each resident to create a unique resident ID that we will use throughout the data collection tool, i.e., you
will use a drop down list of unique resident IDs in the completion of the medication and hospital transfer logs.
NF Name
First
Last
M.I.
Date of Birth
Resident ID
Unique resident ID
Medicare enrollment ID
Medicaid enrollment ID
VA coverage ID
"Medicaid Managed Care (select from dropdown)"
"Medicare Advantage Member (select from dropdown)"
"All other insurance (select from dropdown)"
"CCTP member (select from dropdown)"
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NF admission date
MDS Q0400A
ECCP coverage date
Opt-out date
"Opt-out reason (select from dropdown)"
NF permanent discharge date
"NF permanent discharge reason (select from dropdown)"
NF readmission date for beneficiaries readmitted within 30 days Hospice Election Date
"Eligible for Intervention (select from dropdown)"
PCP Name
"NP/PA Name (select from dropdown)"
Plan of Care (POC)
Advance Directive (AD) Discussions
Medication Management
"Did the resident experience a hospital transfer during this quarter (select from dropdown)"
"Did this resident experience a change of condition* during this quarter (select from dropdown)"
Change of Condition
"Does POC include documentation of resident/family preferences for care (select from dropdown)"
Signed Advance Directive order date
Date of last Advance Directive discussion
"Types of Advance Directives documented (select from dropdown)"
"Conducted by NF or ECCP staff (select from dropdown)"
Medication Review #1
Medication Review #2
Medication Review #3
Medication Review #4
Change of Condition #1
Change of Condition #2
Change of Condition #3
Change of Condition #4
Date of medication review
"Outcome of medication review (select from dropdown)"
Date of change of condition
"Which tools were used to assess and communicate a change of condition (select from dropdown)"
"Did an MD or ECCP NP assess the resident (select from dropdown)"
"Was a root cause analysis tool used (select from dropdown)"
Identified root cause
"What was the outcome (select from dropdown)"
HOSPITALIZATION TRACKING (APRN updates all items as they occur, at least monthly)
This tab is used as a log for each resident transfer from the nursing facility to a hospital. If a resident had multiple
transfers during the reporting quarter, then enter the resident's ID with each transfer listed.
This tab collects information for each instance your residents are transferred out of your facilities and into a
hospital.
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Resident ID
Transfer initiation information
"Date of transfer to Hospital"
"Day of transfer to Hospital"
Transfer: approximate* time of day
Hospital name
"Entity who initially triggered (requested) transfer (select from dropdown)"
Clinician ordering transfer
"Primary nursing facility reasons for transfer: SYMPTOMS (select from dropdown)"
"Secondary nursing facility reasons for transfer: SYMPTOMS (select from dropdown)"
"Primary nursing facility reasons for transfer: DIAGNOSIS (select from dropdown)"
"Secondary nursing facility reasons for transfer: DIAGNOSIS (select from dropdown)"
Additional secondary symptoms or diagnoses contributing to decision to transfer (free text)
"Was a structured communication tool sent to the hospital (select from dropdown)"
Were the advanced directives reviewed at the time of transfer
Were the advanced directives followed
"Outcome of transfer (select from dropdown)"
Transfer from hospital to nursing facility
Hospital discharge date
Length of stay
Hospital primary discharge diagnosis (ICD-9 code)*
Hospital secondary discharge diagnoses (ICD-9 code)*
"Was a structured communication tool received from the hospital (select from dropdown)"
Was the information received from the hospital adequate* to care for the resident during this
transition
Additional Information
Additional comments about this transfer
FACILITY TURNOVER (DON or designee such as HR) submit monthly with form to Jessica)
This tab is used for tracking turnover among CNA, LVN/LPN, and RN nursing facility staff. These data are facilityspecific
and should be completed for each nursing facility participating in the ECCP interventions. Please include all
roles (e.g., RNs who fulfill clinical or administrative roles).
The purpose of this tool is to gather data to track the stability of the nursing facility staff. We understand that
these categories may not encompass all staff in the nursing facility.
The MOQI team needs six numbers from your nursing home each month.
1. Number of CNA staff employed on the First Day of Each Month
2. Number of CNA Terminated by the Last Day of Each Month
3. Number of LPN staff employed on the First Day of Each Month
4. Number of LPN Terminated by the Last Day of Each Month
5. Number of RN staff employed on the First Day of Each Month
6. Number of RN Terminated by the Last Day of Each Month
Below are Q&As from CMS that should help you or your delegated staff to complete the task.
Q: Do I include nurses who perform administrative roles
A: Include nurses who perform direct care and those who fulfill clinical or administrative roles.
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Q: What is a termination
A: An employee departure, either due to firing or quitting, whereby the employee receives a final
paycheck.
Q: Do part-time or per diem staff termination count equally as a full-time staff termination
A: Yes, the calculation is measuring turnover of all nursing staff regardless of individual employment
status.
Q: What about a member of the nursing staff who changes his/her job title and stays in the
organization; does this count as a termination if the employee is still a member of the nursing staff
A: No. Do not count this individual as a termination.
Q: What about a member of the nursing staff who changes his/her job title and stays in the
organization; does this count as a termination if the employee leaves the nursing staff
A: No. Do not count this individual as a termination.
Q: What if a nursing staff member works at two facilities owned by the same corporation and leaves
one of the facilities, but stays at the other
A: The staff member would be coded as a termination by the facility from which he/she departed.
Q: What if a nursing staff employee leaves via a termination, but then is re-hired 3 weeks later
A: He/she would count as a termination.
Q: If a home has 30 budgeted staff positions, but only 25 of the positions are filled, is the number of
staff 30 or 25
A: The number of positions is 25.
Q: What about agency staff Do they count in any of the calculations
A: No. Agency staff are not employed by the nursing home and therefore are not included.
RESIDENT ROSTER DEFINITIONS
The purpose of the Nursing Facility Long-Stay Resident Roster is to capture information on ALL long-stay
residents in the nursing facility during the quarter covered by the report. The requested data elements
are defined in this tab.
These definitions should explain all of the requested data elements in the Beneficiary Roster in sufficient
detail. As mentioned above, technical assistance and additional clarification will be given by the
Operations Support Contractor during office hours.
Nursing Facility Name: The name under which the nursing facility does business.
Nursing Facility Number: The facility's Medicare Provider Number (AUTOMATICALLY GENERATED).
Resident Name: First, Last and Middle Initial – Enter the First and Last name and Middle Initial for the
long-stay resident as shown on their Medicare, Medicaid or VA account or legal name of a resident who
is covered by LTC insurance or is uninsured.
Date of Birth: Date on which the resident was born (MM/DD/YY).
Resident ID: The identification number assigned by the nursing facility to the resident while she/he is in
the nursing facility.
Unique Resident ID: This Unique Resident ID will be AUTOMATICALLY GENERATED by this tool and is
based on the resident's name and date of admission. It will generate a drop-down list in other resident-
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level tabs. This ID will be consistently assigned to the resident throughout the course of his/her stay in
the facility. This ID is being created for purpose of consistency within this data collection workbook.
Medicare Enrollment ID: Enter the ID for a resident eligible/enrolled in Medicare A and/or B at any time
during the reporting quarter.
Medicaid Enrollment ID: Enter the ID for a resident eligible/enrolled in Medicaid at any time during the
reporting quarter.
VA Coverage ID: Enter the ID for a resident for whom the primary payer is the Veterans Administration
regardless of their eligibility for either Medicare and/or Medicaid. (Long stay residents whose care is
paid for by the VA ARE eligible for the intervention.)
Medicaid Managed Care Member: Enter the name of the Medicaid managed care plan in which the
resident is enrolled. If not applicable, enter "None". (Medicaid managed care enrollees ARE eligible for
the intervention.)
Medicare Advantage Plan Member: Enter the name of the plan if the resident is enrolled in a Medicare
Advantage Plan, including Special Needs Plans, and PACE. (Medicare Advantage enrollees ARE NOT
eligible for the intervention.)
All Other Insurance: Enter the status, long-term care insurance or uninsured, for any resident who is
NOT eligible/enrolled in Medicare (A and/or B) or Medicaid or whose care is paid for by the VA.
(Residents who are not eligible/enrolled in Medicare, Medicaid or their nursing facility stay is not paid
for by the VA are NOT eligible for the intervention.)
CCTP Member: Enter Yes if the resident is enrolled in CMS’ Community-based Care Transitions Program
(CCTP) during the reporting quarter. CCTP test models for improving care transitions from the hospital
to other settings and reducing readmissions for high-risk Medicare beneficiaries.
FACILITY-BASED RESIDENT INFORMATION DEFINITIONS
NF Admission Date: Enter the date the resident was admitted to the nursing facility (e.g., on a Medicare
Part A benefit, on a Medicaid covered stay) for use in qualifying the resident as long-stay. This is the
date of the admission that led to the resident becoming long-stay. Examples follow.
a) Mary Smith was first admitted to the nursing facility 06/02/2012, she was transferred to a
hospital on 12/15/2012 and was readmitted to the same nursing facility January 1, 2013. The
NF Admission Date used should be 06/02/2012 as this is the admission that lead to Ms. Smith
becoming a long-stay resident. She would be eligible for the ECCP’s intervention starting
2/1/2013 as she has remained in the facility for greater than 100 days (101st day was
9/11/2012).
b) Mr. Berry was admitted to the nursing facility on 02/01/2012 from the hospital for post-acute
rehab. He was then discharged from the nursing facility on 03/01/2012 back to his home in the
community. After another hospitalization, Mr. Berry was admitted to the nursing facility on
07/01/2012 and has continued to reside in the facility. The NF Admission Date used should be
07/01/2012 as this is the admission that lead to Mr. Berry becoming a long-stay resident. He
would be eligible for the ECCP’s intervention starting 2/1/2013 as he has remained in the facility
for greater than 100 days (101st day was 10/10/2012).
c) Ms. Jones was admitted to the nursing facility on 12/15/2012. He was transferred to the
hospital on 1/5/2013 and returned to the same nursing facility on 1/12/2013. On 2/3/2013 the
facility marked MDS section Q 0400A “0” (no active discharge plan). The NF Admission Date
used should be 12/15/2012 and Ms. Jones is eligible for the ECCP intervention starting 2/3/2013
as the MDS indicated he had no active discharge plan as of this date.
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MDS Q0400A: Enter the answer as reported on MDS Questions 0400 A.
ECCP Coverage Date: Enter the date that the resident began to be covered by the ECCP intervention.
Opt-out Date: Enter the date that the resident chose not be part of the ECCP intervention.
Opt-out Reason: Enter the reason the resident/resident’s representative chose not to participate in the
ECCP intervention.
NF Permanent Discharge Date: Enter the date that the resident was permanently discharged from the
nursing facility. (Any resident returning to the community for more than 30 days is to be removed from
the intervention. Should s/he return to the nursing facility after more than 30 days, s/he will have to
meet the eligibility requirements anew before being covered by the intervention.)
NF Permanent Discharge Reason: Enter the reason for the resident being permanently discharged from
the nursing facility.
NF Readmission Date for Beneficiaries Readmitted within 30 days: Enter the readmission date for a
resident who was discharged to the community and returned to the facility within 30 days. (These
individuals WILL CONTINUE to be eligible for the ECCP intervention.)
Hospice Election Date: Enter the date that a resident chose to receive hospice care IN THE NURSING
FACILITY.
Eligible: Enter Yes or No based on your determination that the resident is eligible to participate in the
intervention based on CMS’ eligibility criteria.
ELIGIBILITY CRITERIA FOR THE INTERVENTION
Residents ARE eligible for the intervention if they:
• Enrolled in Medicare A and/or B and/or Medicaid or their nursing facility stay is paid for by the
VA and
• Have resided in the nursing facility for 101 or more days (including the day of admission) or
• Are identified on the Minimum Data Set assessment Section Q 0400A ("0" - No Active Discharge
Plan)
Residents ARE NOT eligible for the intervention if they meet any of the following criteria:
• Have not resided in the facility for 101 or more days and do not have an answer of "0" for MDS
Section Q 0400A
• Are enrolled in a Medicare Managed Care Plan
• Are not eligible/enrolled in Medicare, Medicaid or their nursing facility stay is not paid for by the
VA
Residents’ eligibility must be re-determined anew if they:
• Return to the community for more than 30 days
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ADVANCE DIRECTIVES DISCUSSION DEFINITIONS
Signed Directive order date: Date that any Advance Directives were signed. If none were signed, then
leave this blank.
Date of most recent Advance Directive discussion: Date of most recent Advance Directive discussion. If
no discussion has been had, then leave this blank.
Conducted by ECCP or NF staff: Select whether this discussion was conducted by a staff person from
the nursing facility or from the ECCP.
Advance Directive documentation: Select whether there is no signed advance directives, signed DNR,
signed DNH, signed DNI, no enteral feeding, or signed full treatment (signed full code).
PCP OF RECORD DEFINITIONS
PCP First Name and National Provider Identification Number: Select the name and the CMS National
Provider Identification Number for the physician of record or primary care provider and who provides
routine care (e.g., visits) for the resident. This category does NOT include the ECCP's staff.
ROUTINE CARE NP/PA DEFINITIONS
NP/PA First Name and National Provider Identification Number: Select the name and the CMS National
Provider Identification Number for nurse practitioner (NP) or physician's assistant (PA) who provides
routine care (e.g., visits) for the resident. This category does NOT include the ECCP's staff.
CARE COORDINATION DEFINITIONS
Does POC include documentation of resident/family preferences for care: Enter Yes or No.
Signed Advance Directive (AD) order date: Enter the date that the current AD documents were signed.
Date of last Advance Directive Discussion: Enter the date that the most recent AD discussion took place.
Advance Directives documentation: Select which AD documents were signed. Note that resident
information must be filled out for the selection box to appear.
Conducted by NF or ECCP staff: Was the AD discussion conducted by NF or ECCP staff
Did this resident experience a change of condition during this quarter: Enter Yes or No.
Date of change of condition: Enter the date the change of condition occurred.
Which Interact tools (or equivalent) were used: Enter which Interact tools were used, if any. If AMDA
or other equivalent tools were used, enter "other".
Did an MD or ECCP NP assess the resident: Enter Yes or No.
Was a root cause analysis tool used: Enter Yes or No.
Identified root cause: What was the result of the root cause analysis If no tool was used, leave blank.
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FOR ECCP USE ONLY
ECCP Staffing
This tab is used for tracking ECCP staffing levels. It is useful for seeing what type of employees/skills the
ECCP is using to implement its intervention. These job types may include: NP Lead, Dental Hygienist,
Dentist, Pharmacy Technician, IT Specialist, HIT Lead, NP, RN, APRN, Care Pathways Coach, Care
Transitions Coach, INTERACT Specialist, Social Worker, Physician Extender, Medical Director, and
Pharmacy Consultant/Pharmacy Faculty Coach. There may also be administrative/support staff
including: Project Coordinator, Financial and Data Analyst, Administrative Assistant,
Intervention/Practice Expert, Care Transitions Lead, and QI Specialist. Additionally, this template
provides a structured tool to track how these ECCP staff spend their time and at which participating
nursing facilities they are working. Note that this tab is for the ECCP itself, and is not facility-dependent
or specific.
Fill these out based on your experience over each month of the reporting quarter. We realize that
staffing levels change and time spent engaging in different activities do as well--please use your best
judgment to determine these percentages.
ECCP Employee Name
ECCP Employee Role
NPI or Alternate ID
Hours per week at facilities
Current resident caseload
% of time providing direct care
% of time providing education
% of time engaging in communication
% of time engaged in activities related to advanced care planning and/or advance directives
% of time performing administrative tasks
Scheduled hours spent in the facilities (Days)
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