Quality Measures: Final Exam
Which of the following is not true about the MDS 3.0 Quality Measures?
They are intended to be the one tool consumers need to select a nursing home for a loved one.
They provide a comparison of a facility’s scores to national averages.
They offer the opportunity to compare a facility’s QM scores to other facilities’ scores.
They represent resident outcome information specific to a facility.
How often is the facility-level MDS 3.0 Quality Measure data calculated in CASPER?
Daily
Weekly
Monthly
Every six months
Which of the following is not a function of the nursing home MDS 3.0 Quality Measures?
Publicizing differences in quality among nursing homes
Contributing to the Five-Star quality rating
Fostering improvement in care in nursing homes
Requiring nursing homes to participate with Quality Improvement Organizations
What is the purpose of the CMS Nursing Home Quality Initiative?
To promote competition among nursing home providers.
To require all nursing homes to participate in Quality Improvement Organization activities.
To provide periodic ratings for each Medicare- and/or Medicaid-certified nursing home.
To improve the quality of care in nursing homes.
During the month of November, your MDS 3.0 Facility Level Quality Measure Report reflected a denominator of 104 for residents with “Percent of Resident Who Newly Received an Antipsychotic Medication (S).” Your facility only has the capacity for a census of 90 residents. Which of the following is the most likely reason for the discrepancy in the size of the denominator?
The QM look-back scan selection logic used
The report period selected
The QM target assessment selection logic used
The run date selected
What is a covariate?
A covariate is used to risk-adjust for individual resident characteristics when calculating Quality Measure(s).
A covariate is a type of resident that is not included in the calculation when determining Quality Measure(s).
A covariate is the new occurrence of a Quality Measure condition over a period of time.
A covariate is used to eliminate an individual resident from the QM calculation.
What is the effect of the cognition covariate for the long-stay MDS 3.0 QM “Percent of Residents Whose Ability to Move Independently Worsened”?
It decreases the QM score due to a worsening in ability to move.
It stratifies the results based on ability to locomote independently.
It results in exclusion of the resident from the calculation, since he or she is unable to make-self understood.
The facility’s QM score is adjusted to compensate for residents who have severe cognitive impairment.
For the CASPER 3.0 QM “Percent of Residents Whose Ability to Move Independently Worsened (SNF Only)”,” four of the covariates are related to ADL performance in section G. What is the effect of those covariates on the facility’s QM score?
They exclude the resident from the calculation; as a result, they have no effect on the QM score.
They increase the QM score to account for the higher level of care required for those types of conditions.
They have no effect on the final score.
They level the playing field for a facility that has more residents with the covariate conditions than other facilities have.
Which of the following best describes selection of residents for computing MDS 3.0 Quality Measures?
Residents whose latest episode ends during the target period or is ongoing at the end of that period.
Residents with an OBRA Admission assessment with an ARD during the target period.
Residents with a stay that ends during the target period.
Residents identified during the look-back scan.
For the MDS 3.0 QM “Percent of Residents Who Made Improvements in Function (Short Stay),” what happens to the QM score for a facility that has a typical proportion of residents with the covariate conditions?
The QM score will be higher than the observed score.
The QM score will be lower than the observed score.
No effect on the score.
Unknown: It depends on how many residents are in the numerator.
When the Resident Mood interview was completed, what conditions must be met for the long-stay MDS 3.0 QM “Percent of Residents Who Have Depressive Symptoms”?
Any two of the symptoms in item D0200, Resident Mood Interview, items A – I, column 1, are scored a 1
All symptoms in item D0200, Resident Mood Interview, frequency (column 2), must be coded 2 or 3 for frequency.
Item D0200A (little interest or pleasure in doing things) and D0200F (feeling bad about yourself) must be coded 2 or 3 with the overall Total Severity score being at least 5.
Either D0200A (little interest or pleasure in doing things) or D0200B (feeling down, depressed, or hopeless) must be coded 2 or 3 for frequency and the Total Severity score must be 10–27.
Which MDS item provides the primary information for the numerator for calculating “Percent of Residents Who Newly Received Antipsychotic Medication (Short-Stay)” for the MDS 3.0 Quality Measure?
N0410A, Antipsychotic; N0410B, Antianxiety; and N0410C, Antidepressant
N0450A, Did the resident receive antipsychotic medication since admission/entry or the prior OBRA assessment, whichever is more recent
N0410A, Antipsychotic
N0450C, Date of the last attempted gradual dose reduction
For the long-stay MDS 3.0 QM “Percent of Residents Experiencing One or More Falls With Major Injury,” which of the following is true?
The fall with injury may be coded on any qualifying assessment in the resident’s episode to affect the QM score.
The fall with injury must be coded on the most recent assessment in the quarter to affect the QM score.
The fall with injury must have occurred during the current stay to affect the QM score.
The fall with injury must be recognized within four hours of the fall.
Which of the following describes Cumulative Days in Facility (CDIF)?
They require the resident to discharge from the facility to end the CDIF.
They include only Medicare Part A days.
The include the total number of facility inpatient days within an episode.
They include inpatient hospital days within an episode.
What is the statistical technique that adjusts the Quality Measure score to account for resident conditions that are largely out of the control of the facility staff?
Numerator
Risk adjustment
Look-back scan
Observed value
Which of the following assessments would be used to calculate the long-stay QM “Percent of High-Risk Residents With Pressure Ulcers”?
Quarterly assessment
Admission Assessment
PPS 5-Day assessment
PPS Interim Payment Assessment
Which of the following is a high-risk condition for the long-stay QM “Percent of High-Risk Residents With Pressure Ulcers”?
Hospice
Impaired dressing
Impaired bed mobility with a score or 3, 4, 7, or 8
Swallowing problem
While reviewing their MDS 3.0 Facility-Level Quality Measure Report, the SNF personnel noted that the “Facility Observed Percent” for Resident who Used Antianxiety or Hypnotic Medication (L) had jumped from 16% to 27.6% since the previous month’s printing. Which of the following is the most likely reason for this significant variance?
The QM target assessment selection logic used
The report period selected
The QM look-back scan selection logic used
The coding of the MDS
Which of the following is not included in the definition of “high risk” for the MDS 3.0 Quality Measure “Percent of High-Risk Residents With Stage 2-4 or Unstageable Pressure Ulcers”?
Hospice
Impaired transfer
Comatose
Malnutrition
How is the long-stay MDS 3.0 QM “Percent of Low-Risk Residents Who Lose Control of Their Bowel or Bladder” computed?
Excluding low-risk conditions and determining the proportion of the remainder who meet the QM definition of losing control of bowel or bladder
Excluding high-risk conditions and determining the proportion of the remainder who meet the QM definition of losing control of bowel or bladder
Applying covariates “incontinent of bowel or bladder” and “ADL dependence”
Defining low risk based on frequency of incontinence episodes.
In what scenario will a resident’s MDS data increase the score of the MDS 3.0 Quality Measure “Residents Whose Need for Help With Activities of Daily Living Has Increased”?
The resident has a prognosis of life expectancy of less than six months.
The resident has a one-level decline in any of the late-loss ADLs.
The resident has a two-level decline in any of the late-loss ADLs.
Three of the late-loss ADLs indicate total dependence and the fourth indicates extensive assistance on the prior assessment.
What is the definition of “short stay” for computing Quality Measures?
Resident has the 5-Day SNF PPS assessment in the database during the reporting period.
Resident has an IPA assessment in the database during the reporting period.
Resident has 100 or fewer cumulative days in the facility.
The length of stay of the most recent stay was 100 days or less.
Regarding the Facility-Level MDS 3.0 Quality Measure Report for the survey process, what is the “percentile rank”?
It is the risk-adjustment technique that decreases the QM score if the facility has a lot of residents with the covariate conditions.
It indicates the percentage of facilities nationally that scored better on the QM than your facility did.
It reflects the facility’s performance compared to facilities in the same state.
It indicates the facility’s performance; the higher the percentile rank, the better the care.
With the MDS 3.0 Quality Measures, what is the definition of a “stay”?
The period spanning the total number of days within an episode.
A period of time between a resident’s admission to and discharge from the facility or the end of the target period.
A period of time between a resident’s admission and a discharge of any type.
A period of time between a resident’s entry into a facility and a discharge from the facility or the end of the target period, whichever comes first.
The percentage of long-stay residents whose need for help with late-loss activities of daily living (ADLs) has increased when compared to the prior assessment. This QM triggers when which of the following occurs in coding a resident’s self-performance?
A review of all ADLs in item G0110 indicates that on two or more of these ADL activities the resident is newly coded as Extensive assist, Total assist, or Activity did not occur.
A review of Bed Mobility, Transfers, Eating, and Toilet Use in item G0110 indicates that on two or more of these ADL activities the resident is newly coded as Extensive assist, Total assist, or Activity did not occur.
A review of all ADLs in item G0110 indicates that the resident’s coding points have decreased by two or more points in one area or one point in two areas.
A review of Bed Mobility, Transfers, Eating, and Toilet Use in item G0110 indicates that the resident’s coding points have increased by two or more points in one area or one point in two areas.
Which of the following is true regarding how a Quality Measure is calculated?
Each of the Quality Measure calculations is risk-adjusted.
The basic calculation for each measure consists of a simple ratio expressed as a percentage.
The numerator for each measure consists of all residents who could have the condition.
The denominator for each measure consists of all residents in the facility.
