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STRIVE Project: CMS initiates a new national nursing home time study
The Centers for Medicare & Medicaid Services (CMS) has initiated a national nursing home staff time measurement (STM) study, the Staff Time and Resource Intensity Verification (STRIVE) Project. The STRIVE project represents the first nationwide time study for nursing homes in the United States to be conducted since 1997, and will provide accurate information for updating payment systems for Medicare skilled nursing facilities (SNFs) as well as Medicaid nursing facilities (NFs). The study is collecting staff time and resident-level clinical data regarding health status, medical conditions, services received, and facility resources used to provide care from a large sample of nursing homes. On September 30, 2005, CMS contracted with the Iowa Foundation for Medical Care (IFMC) to collect data and provide analysis for the STRIVE project.
CMS currently reimburses Medicare Part A SNF services on the basis of a prospective payment system (PPS), which uses the Resource Utilization Groups, version 3 (RUG-III) classification system to determine payments based on patient data. This system was introduced in 1998, and was constructed on the basis of STM studies conducted in 1990, 1995, and 1997. CMS believes that the introduction of the current prospective payment system may have altered industry practices, and significantly affected the nursing and other staff resources required to treat different types of patients. Accordingly, CMS plans to use the data from the upcoming time study to recalibrate the RUG-III case-mix weights used to determine payment rates. This updated information will reflect the most recent care practices and resource needs of nursing homes.
CMS is working with State agencies and nursing home associations to make this STM study a comprehensive examination of both post acute and long-term care populations. Almost half of the States use a version of the RUG-III classification system to pay for nursing home care under their Medicaid programs.
IFMC, which has been awarded the contract for the study, has assembled an expert team from around the country: Brant Fries, Ph.D. (University of Michigan); Robert Godbout, Ph.D. (Stepwise Systems, Inc.); David Malitz, Ph.D. (Stepwise Systems, Inc.); and Dave Oatway, M.P.H. (CareTrack Systems, LLC). A pilot study of the data collection systems and procedures is scheduled for late winter 2006. Data collection began in spring 2006, with completion scheduled for the spring/summer 2007. Thorough analysis of this data will continue through the winter of 2007 and recommendations are expected in late 2007 or early 2008.
On December 1, 2005 IFMC held a Technical Expert Panel (TEP), which solicited input on topics ranging from validation of the overall design for STRIVE to special patient populations requiring focused data collection needs from provider and industry advocates. Slides from the TEP are available below, under Downloads.
In addition, on December 13, 2005 CMS held a special Open Door Forum on the time study, in which the public called in with questions and comments. Slides from the Open Door Forum are available at the Related Links Outside CMS. More material is available on the Time Study (STRIVE) site, including the newsletter, slides from a May 2006 Technical Expert Panel teleconference, and Frequently Asked Questions. Minimum Data Set, Version 3 (MDS 3.0) and STRIVE In April 2003, the Centers for Medicare & Medicaid Services (CMS) issued a contract to RAND to evaluate proposed revisions to the Minimum Data Set for Nursing Homes (MDS 3.0). A draft version of the MDS 3.0, a timeline and background information is now available on the MDS 3.0 website (see Related Links Inside CMS below). One of the reasons for the MDS 3.0 revision is to make the MDS more clinically relevant, while still achieving the federal payment mandates and quality initiatives. This draft is based on the results of a national clinical validation study. The MDS 2.0 instrument has not had extensive clinical updating since 1995. Proposed MDS 3.0 clinical changes are based on extensive written and oral provider feedback, a Town Hall meeting, CMS/Veterans Administration Research Collaborative, technical expert review and data collection in 8-States. CMS now plans further evaluation, which will include analysis of the impact of this assessment instrument on the resident classification system, Resource Utilization Group (RUG-III), used in the Medicare payment structure. This evaluation is conducted as part of the STRIVE study. Accordingly, the final MDS 3.0 may contain new or changed items from those presented during the January 2008 Open Door Forum. Please look for updates on the Skilled Nursing Facilities PPS Highlights web page. We invite your comments and questions on the time study. Please address them to STRIVE@IFMC.ORG.
Page Last Modified: 12/30/2008 9:21:38 AM
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