Nursing home quality
care indicators that the Centers for Medicare and Medicaid Services plan to publicize
on every institution in the nation will likely not differ much from the indicators
that CMS will track during an upcoming pilot project in select states, an agency
official said April 8.
'I think we will
see that the national initiative will use very similar measures,' CMS Health and
Human Resources Deputy Director Paul Elstein, PhD, told the American Association
of Homes and Services for the Aging during their spring conference. 'They may
not be the same exact measures, but they will be close,' he added.
Starting April
17, CMS will post on its 'Nursing Home Compare' website ratings for nine quality
of care indicators for every home in Colorado, Florida, Maryland, Ohio, Rhode
Island and Washington. Chronic care measures include percentages of long-term
patients who need help doing daily activities, have multiple bedsores, have lost
more than 5% of their initial weight, are in pain, have infections or need daily
physical restraints. Post-acute measures for short-stay home residents include
the percentages of patients who suffer from delirium, are in pain or who have
seen an improvement in walking. The official release of the data – which
CMS has been collecting for years – will be followed April 18 by a major
ad campaign in all of the selected states’ major newspapers.
CMS anticipates
that a success in the pilot program will allow the government to expand the data
publications to all nursing homes throughout the country, Elstein explained. 'The
final results will be used to inform the national initiative,' he said. CMS Administrator
Tom Scully told the Association of Health Care Journalists April 8 that the agency
expects to roll out the national nursing home quality program in 2003, followed
by a home-health survey the following year and a general hospital quality program
possible in 2005.
The agency designed
the pilot ratings in the six states – which were chosen for their expressed
interest in tackling such quality improvement issues – to serve not as a
means to regulate nursing homes but instead to provide consumer assistance for
individuals who are researching the facilities. Elstein noted that a recent pilot
project focusing on facilities in Massachusetts found that the same measures were
valid indicators of which homes were performing well for residents and their families.
But despite Elstein’s
confidence that the nine base indicators can comprise a good consumer tool that
is applicable on a national level, many AAHSA delegates at the conference predicted
that the CMS ratings would instead publish skewed data that punishes homes through
decreased admissions. 'We already know [from a March General Accounting Office
report] that there are inaccuracies in the data that CMS has been collecting on
these nursing homes,' one facility administrator remarked. 'I’m uncomfortable
with the fact that the data will be used to drive what will be a very public enterprise.'
AAHSA itself, which
represents roughly 5,600 not-for-profit nursing homes, cannot yet release an official
response to the CMS pilot program because the agency is continually updating and
adjusting its data collection for the project, the organization’s spokesman
said April 8. However, AAHSA Institute for the Future of Aging Studies Director
Robyn Stone told AARP Feb. 14 that the pilot program would be 'at the best, a
joke; at the worst, it could set back quality activity 10 years.'
American Health
Quality Association Executive Vice President David Schulke and CMS Office of Clinical
Standards Director Jeffrey Kang, MD, joined Elstein in pushing the new initiative
as a quality collaboration between nursing homes and the government rather than
as a means by which the agency can further regulate the industry. Kang characterized
the data release as one of the ways in which CMS can stress continual quality
improvement rather than relying on regulations and standards that amount to 'blaming'
the industry for mistakes.
Schulke, who as
one of the directors of the nation's Quality Improvement Organizations has contracted
with CMS to help homes make necessary improvements once the quality ratings become
public information, maintained that the pressure will not solely rest on the institutions
themselves to get up to speed. 'The QIOs will be accountable for your improvement,'
he told the AAHSA audience. 'If they do not succeed in raising state quality levels,
QIOs will be the ones who will be in trouble.'
