|
HOW WILL QIO'S
HELP NURSING HOMES IN NEW RATING SCHEME?
If the federal
government's new scheme to help consumers compare nursing homes is going to work,
"Quality Improvement Organizations" will have to be a big part of the
reason why. Through links to the 1-800-Medicare number, QIOs will help consumers
understand how to use new comparative ratings to be published in ads in six states
the week of April 22. And they'll help homes that want help figure out how to
improve on the ratings, which will let the public compare facilities on managing
pain, improvement in walking, avoiding use of restraints, preventing bed sores,
delirium, and infections, and preserving the ability of residents to perform various
functions of daily living.
The way things
are shaping up right now, however, some homes may be looking for more help than
QIOs will be able to give them, QIO officials acknowledged today in a question
and answer session with reporters.
The new initiative
marks the first time that the quality improvement entities, until recently known
as peer review organizations, are tied directly into public disclosure of how
individual health care facilities perform from a quality standpoint, David Schulke,
executive director of the American Health Quality Association (AHQA) said at a
briefing this morning. The tie-in is potentially powerful since homes worried
about being punished in the marketplace presumably will be anxious to find ways
to improve. But some homes will get more help than others - and that may not be
the way homes want it.
The ratings will
be published in newspaper ads listing how local homes do on a couple of measures,
with references to much more wide-ranging comparative data on a web site. Thus
the ad could list what percentage of residents in each nursing home in Montgomery
County, MD, has bed sores, and compare these against a national percentage, for
example. Those comparisons are available now on the Medicare.gov web site, but
they aren't adjusted for risk. Thus, a home with a higher percentage of bed sores
might actually do a better job of preventing them than a home with a lower percentage
because it treats sicker patients. But when the new ratings come out, they'll
be apples-to-apples comparisons that adjust for the fact that a home might have
sicker patients, a CMS spokesperson says.
The QIO program
of assistance is strictly voluntary - there is no requirement that homes seek
such help. But "in every state, QIOs will provide all nursing homes with
up-to-date information and strategies for establishing an organizational structure
that supports quality improvement," AHQA said. "The materials focus
on guidelines for proper care, methods for improving care, staff training information,
model policies and protocols, and tools for assessing care." Thus homes will
be able to assess themselves to identify problem areas and will get information
teaching them how to make their own improvements.
QIOs will offer
"hands-on assistance" to up to 10 percent of homes in each state. Six
states are in the pilot program for which ratings will come out around April 24th
- Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington. The Centers
for Medicare and Medicaid Services plans a national rollout of the quality initiative
in October. Early indications are that facilities are eager to be part of the
group that receives intensive assistance. Schulke said that at information meetings
thus far between QIOs and homes, facility representatives have been trailing QIO
representatives out the door hoping to be included among those receiving intensive
help.
In homes receiving
intensive assistance, QIOs "will help staff identify leadership roles, establish
clinical care teams, and learn a process for continuously improving quality of
care," AHQA says. "Focusing on specific clinical indicators, teams will
perform clinical assessments, establish new policies and treatment protocols,
provide additional staff training, and assess whether the changes cause sustainable
improvement in care."
The aim of the
quality improvement effort is to implement systems of care. The idea is to have
procedures that catch errors before they affect the patient, and to have a structure
that allows improvements to be made; quality shouldn't depend on having a few
knowledgeable caregivers around who may come and go. Obviously, homes that aren't
part of the select group will have to be much more self-reliant in getting systems
going. All long term care facilities will have the chance to get support through
workshops.
CMS is going to
be holding QIOs accountable for how well they help homes improve care. QIOs will
be asking providers, "what will help you improve? Clinical pathways or protocols?
Data collection tools (e.g. chart abstraction)? Preprinted physician orders? Patient
education materials? Provider education materials (articles, guidelines)? Analysis
of Minimum Data Set data? Onsite workshops or seminars for staff? Other project
specific assistance?"
QIOs already have
a track record of improving nursing home quality in 27 states, AHQA officials
say. A project led by the Alabama Quality Assurance Foundation involving 14 nursing
homes reduced falls by residents by an average of three falls per 100-bed facility
per month. In Alaska, PRO-West led a program involving 26 facilities that increased
the percentage of residents receiving pneumococcal vaccinations from 53 percent
to 74 percent.
An unofficial estimate puts the three-year budget for QIOs for quality improvement
work at $100 million per year over a three year-period. About $75 million is for
nursing home and home health work, with each sector getting $37-to-$38 million
apiece. Schulke said it's possible that if homes aren't getting the help they
want from QIOs that industry will try to seek an increase in that level of funding.
|
