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QIOs GET MORE
CMS MONEY TO IMPROVE NURSING HOME CARE, BUT...
There's nothing
like publicity, it seems, to fuel activity by nursing homes to improve their quality
of care. A six-state pilot project by the Centers for Medicare and Medicaid Services
to take out local newspaper ads comparing the quality of local homes has led many
facilities to seek help creating internal systems to improve quality of care,
officials said in a press briefing today. CMS Administrator Tom Scully has agreed
to find more money for Quality Improvement Organizations (QIOs) to help homes
that request it, said David Schulke, executive director of the American Health
Quality Association. AHQA represents QIOs, which contract with the federal government
to improve care in hospitals and nursing homes.
Scully has agreed
to take $35 million from a QIO support budget - there's a distinction between
"support" funds and "direct" funds -- and to give it directly
to the quality improvement entities to fund their work with nursing homes. "We
are glad to have it," Schulke said. "They didn't have to do it."
But he added that that's only one-third of the added money QIOs need to respond
to high demand by nursing homes for assistance. CMS must get approval from the
White House Office of Management and Budget to provide the other two-thirds, Schulke
said. "I think they are trying to figure out how to persuade OMB to spend
the other two-thirds," he added.
Nursing homes,
QIOs, ombudsmen programs, and state officials are gearing up for when the 6-state
pilot goes national in October. The $35 million is earmarked for efforts nationwide
by QIOs to either go directly into homes to help establish quality improvement
systems or to fund "collaboratives" - joint efforts by QIOs and providers
to foster best practices. Failure to get the other two-thirds would mean modest
efforts in these areas.
"Original
plans called for QIOs to provide information on quality improvement to all nursing
homes and to provide intensive on-site training to 10 percent of facilities in
each state," AHQA said today. "However, reports from the six pilot states
so far show 25-to-40 percent of all nursing homes participating in statewide workshops
and 10-to-20 percent of all facilities seeking intensive training."
An industry official
said that the approximately 17,000 facilities affected by the publicity initiative
are "anxious" about the October rollout. Facilities in the six-state
pilot that didn't perform well on the quality measures publicized haven't reported
a loss of business, the briefing indicated. However, the number of requests for
QIO assistance and the intensity of help facilities requested has been unexpectedly
high. It appears that the pilot is working the way CMS hoped it would, with ratings
fueling serious quality improvement efforts by facilities. CMS also envisions
ombudsmen programs working with consumers to rely on the ratings as just one factor
in picking a home.
Industry seems
to be cooperating in the initiative, but would like to see measures described
in a more positive way. As an example, an official said that rather than say 17
percent of a facility's patients have pressure ulcers, the ratings should say
that 83 percent of a facility's patients "are ulcer-free."
But the initiative
seems to be sparking genuine excitement about the potential for quality improvements.
CMS-funded newspaper ads that ran in the six states (OH, MD, FL, WA, Co, and RI)
in May "were like a starter's gun at a race" that got everyone's attention,
said Schulke. He sees stakeholders in long term care paying "tremendous,
and possibly unprecedented attention" to quality right now. Fears that facilities
would react to QIOs with suspicion haven't been borne out. Representatives of
industry and ombudsman programs at the briefing expressed enthusiasm about working
together to improve quality, but emphasized a need for patience and the building
of partnerships by all the players involved, particularly at the state and local
level.
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