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Given a report on quality assessment activity, evaluate compliance with applicable standards in a specific functional area and prepare a consise memo outlining your findings.
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Medicare's 5-Star Rating System

I learned that Orchard Park is not accredited in the normal sense, such as with The Joint Commission.  I was told that the facility was just not large enough for that kind of accreditation.  They do, however, have a Medicare Rating of 5 Stars.  There are a limited number of facilities that can hold a 5-star rating.  If a facility drops below their 5-stars, they have to wait until a different facility drops before they could get up to 5-stars again.  They have to work very hard to maintain that high rating.  I researched this rating and learned that it is a nursing home comparison and quality rating system that Medicare uses.  They use three different types of assessments:

 

  1.  Health inspections, where they use the past 3 years of onsite inspection of both standard surveys and complaint surveys.  The information is gathered by trained, objective inspectors who go onsite to the nursing homes and check on the extent at which the facility is meeting the Medicare and Medicaid minimum quality requirements.

  2. Staffing, which gives information about the number of hours of care that are provided on average to each patient, each day by the nursing staff.  They consider the levels of needed care, for example making sure that facilities who care for patients with more severe needs have more staff available.

  3. Quality Measures (QMs) which give information on 11 different physical and clinical measures for nursing home residents.  They recently included information on the nursing homes' use of antipsychotic medications in both long-stay and short-stay.

 

Five-star quality rating system.  Centers for Medicare and Medicaid Services.  Retrieved from

https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html

 

Other Compliance Efforts at Orchard Park include:

 

  • Triple Check, which is a monthly meeting process designed to review the facility's Medicare claims before submitting the claims to Medicare.  For more information about Triple Check, please click here.

  • Use of Abaqis, which is a Quality Management software program that is accessable online.  The goal of Abaqis is to help healthcare facilities to be ready for surveys by recognizing deficiencies.  For more information about Abaqis, please click here.

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