In 2019, there were some very real issues in long-term care that were identified in the state of Oklahoma. In October of the same year, the Oklahoma Health Care Authority (OHCA) implemented a new program called “Pay for Performance” (or PFP) for long-term care Medicaid certified facilities in the state. This new program, which was passed through Senate Bill 280 titled “Nursing Home Quality Assurance Initiative,” established four equally important measures already in place by the Centers for Medicaid and Medicare Nursing Home Compare website.
Every individual in long-term care deserves to have the highest level of care. As stated on the OHCA website (scan the QR code below to see the full site for statistics and more information), this program is designed with the quality care of residents in mind. It leans on the integrity, quality, and overall wellness of our populations most vulnerable. Providers receive payment based on the quality and value of the services that they provide.
The PFP Program Mission (From OHCA)
To allow nursing facilities that are established and rooted in Oklahoma the opportunity to achieve above and beyond the standard level of care already being provided. This program is goal oriented to enrich the nursing facilities overall quality of care.
The PFP Program Vision (From OHCA)
Our vision is that all facilities will receive incentive reimbursement, and the state of Oklahoma will have the top-rated care in nursing facilities across the nation. This will enhance not only the nursing facilities and their employees, but the lives of Oklahomans and their families.
The Four Quality Measures
N024.02 – Percentage of long-stay residents with a urinary tract infection
N015.03 – Percentage of long-stay residents with high risk/unstageable pressure ulcers
N031.03 – Percentage of long-stay residents who received an antipsychotic medication
N029.02 – Percentage of long-stay residents who lose too much weight
Measure N024.02 – UTI Prevention
Urinary Tract Infections (UTI’s) are one of the most common infections for those living in long-term care facilities, with reports indicating that up to 21.8% of residents may experience it. Additionally, reports show that up to 57% of women and 38% of men may experience this infection asymptomatically. Since 2019, the state of Oklahoma noticed a 10% improvement in comparison to the rest of the country.
Measure N015.03 – Pressure Ulcer Prevention
Pressure Ulcers (also known as pressure sores or bedsores) occur when excessive force is put on the skin over longer periods of time, typically caused by resident neglect in long-term care. Studies show that as many as one quarter of long-term care residents may develop a pressure ulcer due to neglect. Since 2019, the state of Oklahoma noticed a 32% improvement in comparison to the rest of the country.
Measure N031.03 – Antipsychotic Medication Reduction
The use of antipsychotic medication is a method to help patients with certain mental health conditions, but it comes with side effects and could be very harmful for others. Nearly 14.5% of residents nationwide are being treated with some form of antipsychotic medication. Addressing resident needs through other means (ex. higher staffing ratios) may help lower the need for these treatments. Lower percentages of antipsychotic medication treatments are better on this specific measure. Since 2019, the state of Oklahoma noticed a 60% improvement in comparison to the rest of the country.
Measure N029.02 – Weight Loss Prevention
Weight loss in long-term care residents is a cause for concern. Nearly 8.2% of the nation’s long-term care residents currently suffer from weight loss. This can be caused by many factors, including but not limited to neglect (due to understaffing), cognitive impairments, physical limitations, or poor nutrition programs. The state of Oklahoma now ranks #1 overall in the United States in weight loss prevention, with under 4.5% of its residents currently seeing a reduction in weight. This is close to a 98% improvement since 2019, when the PFP program was implemented.
How Far We’ve Come
When the PFP program began, the state of Oklahoma ranked in the bottom two percent of the nation in all four of the quality measures. At the end of 2022, Oklahoma has improved their overall ranking in all four measures, and now leads the nation in quality measure N029.02 – Percentage of long-stay residents who lose too much weight. Voyage LTC Chief Operations Officer Kip McElwee weighed in on the recent data stating “I think it’s long overdue. Our frontline heroes have had a tough job over the last few years, and these numbers are a testament to their work. Recognition is long overdue, and it is essential that we recognize them.”
This is welcoming news for long-term care providers and leaders across the state, with Rep. Marcus McEntire and Sen. Roger Thompson recently applauding the improvements. “We are so proud of these recent numbers, and we are expecting to climb even higher in the coming years” says Voyage LTC’s CEO Brad Underwood. There is still a long way to go, but with innovative providers such as Voyage LTC, Oklahoma will continue to lead the charge in providing the highest quality of care in the nation.