To determine which residents that will be included in the numerator all scheduled PPS assessments, OBRA Assessments, Discharge Assessments and SNF PPS Part A Discharge Assessments will be reviewed. This is known as the look back scan.
This measure also has several risk adjustments (covariates) that will also be factored into the calculation of the QM. Each of the following covariates will be determined based on the coding of the initial assessment (first assessment) completed for the resident:
Requiring limited or more assistance in bed mobility self performance.
Bowel incontinence at least occasionally.
Diagnosis of diabetes or peripheral vascular disease.
Low Body Mass Index (BMI)
Resident’s who meet any of the covariate requirements will still be included in the overall QM calculation (they are not exclusions) however the facility overall score will be adjusted to account for these resident characteristics that place the resident at higher risk of developing pressure ulcers.
Example 1: Mr. Jones was admitted to the SNF directly from a 3-day hospital stay. Mr. Jones was in the SNF for a total of 75 days and then discharged to home. His initial assessment (Admission/5-day) indicates that he had no pressure ulcers. His 30-day assessment indicates that he developed a Stage 2 pressure ulcer that was appropriately coded in M0300B and M0800A. This would be considered a new or worsened pressure ulcer and Mr. Jones would meet the criteria for this quality measure.
Example 2: Mrs. Smith is admitted to the SNF after an extended hospital stay of 2 weeks. Mrs. Smith was noted to have a Stage 3 pressure ulcer of the right heel upon admission and was appropriately coded on the initial assessment (Admission/5-day) in M0300C as present on admission. The pressure ulcer remained a stage 3 during the entire stay. Mrs. Smith would not qualify for this QM as she was admitted with the pressure ulcer and it did not worsen nor did she develop any other new pressure ulcers (M0800).