The Centers for
Medicare and Medicaid Services Nursing Home Quality Initiative pilot program rollout
has been postponed until the week of April 22.
Scheduling problems
between HHS Secretary Tommy Thompson, CMS Administrator Tom Scully and others
slated to attend a press conference originally slated for the week of April 15
have resulted in the one-week delay, a CMS spokesman said. Scully previously had
stated that nursing home quality data would be available on CMS’ website
April 17 and published the following day in newspapers in the six states participating
in the pilot program.
At an American
Health Quality Association briefing April 12, the group’s executive vice
president, David Schulke, explained that the decision to push back the launch
reflects the importance of improving nursing home quality to the HHS secretary.
'The secretary actually cares a lot about this thing and he wants to be there'
when the program launches April 24, he said. The quality improvement initiative
is set to expand nationwide in October, with similar reports on home health agencies
planned for 2003 and on hospitals in 2005.
The AHQA rep said
that his group and its membership, comprised of quality improvement organizations,
intends to bolster the initiative with its own public outreach efforts. The QIOs
are 'trying to make sure that as many people as possible understand this....They’re
going to do direct outreach to consumers,' Schulke explained. AHQA and its member
organizations are undertaking several efforts, including sending representatives
to speak at senior centers and linking hotlines to CMS’ 1-800-MEDICARE number,
he said. AHQA Communications Director Richard Deutsch also commented that the
trade group expects QIOs in the six states to engage local news outlets in getting
the word out to consumers in concert with CMS’ publication of the data.
At a recent meeting
of the American Association of Homes and Services for the Aging, Scully indicated
that the data being used for the nursing home reports are not likely to be understood
by most consumers and that the initiative will be of limited value in assisting
consumers with selecting a facility.
Schulke acknowledged
that most people are compelled to choose a nursing home under short time constraints
and thus likely would not be able to review and learn to understand the data.
However, he added, 'there is a substantial minority of people who look for nursing
home care who have time to evaluate the data.' Schulke explained that 'most of
the consumers that are going to use the data are daughters and daughters-in-law
who tend to take care of the elderly at home until they need to go to a nursing
home,' which allows them the opportunity to delve more deeply into quality measures
and other informational resources before making a decision. Echoing Scully’s
remarks, he described the quality initiative data as 'a conversation starter'
rather than a definitive tool.
In addition to
the public outreach efforts, Schulke said, AHQA and QIOs are making contact with
'critical intermediaries' such as state and local long-term care ombudsmen and
hospital discharge planners. Consumers already make frequent use of ombudsmen
when research facilities, he said, and 'if that’s the place that families
are going to get that information, it’s vital that the QIOs are working
with them making sure that they understand the indicators.'
More importantly,
Schulke maintained, the public disclosure of nursing home quality information
will drive providers themselves to engage in improvement activities. The program
'should motivate the providers...to conduct more introspective examinations of
their own quality and to undertake efforts to improve that quality,' he explained.
Although there
may be 'a second wave of pressure that’s driven by consumers,' he proposed,
'providers have always responded more quickly to this kind of published data than
consumers have.' Shulke averred that this could be construed as an advantage of
the initiative because 'those are the people that actually have to make the change
anyway.'
Nursing homes are
not required to work with QIOs on reform programs, but Shulke suggested many will
sign on anyway. In fact, he said, 'probably the big issue will be whether the
QIOs are able to respond to all the demand.' AHQA and its members have not begun
actively recruiting nursing homes, he said, but already have perceived of great
interest in discussions with facilities. In order to determine what nursing homes
will selected, he stated, CMS and QIOs will have to consider those that appear
to need the most help weighed by those most willing to participate. If QIOs find
that they are unable to accommodate enough nursing homes that fit these criteria,
Schulke said AHQA is prepared to petition the agency for additional funding.
QIO efforts with
nursing homes will take place on three levels, Schulke continued. In addition
to widely distributing quality information to nursing homes and effecting some
site visits, AHQA will help coordinate collaborations between facilities attempting
to resolve the same clinical problem to share best practices advice and other
information. AHQA also will host a stakeholders meeting in Baltimore July 24-25
to review the outcome of the pilot program and devise suggestions to improve the
initiative for its national expansion. The group will present recommendations
to CMS following the meeting.
Another key guarantee
that the quality initiative will have an impact, Schulke argued, is that CMS will
keep a keen eye on the results. 'I think Mr. Scully and the secretary have got
the industry’s attention,' he said, which is 'really going to facilitate
a much more rapid uptake of clinical improvement activities than otherwise would’ve
happened' without the program. Moreover, 'CMS is monitoring the [initiative]...and
if the QIOs don’t successfully facilitate improvement, it will be noticed
and they will be on the block,' he said.
