Eli's Long Term Care Report Aug. 9, 2002 Quality of Care QUALITY INITIATIVE GETS EXTRA FUNDS, BUT STILL COMES UP SHORT When the Centers for Medicare & Medicaid Services launched its Nursing Home Quality Initiative earlier this year, it didn't anticipate that demand for quality improvement assistance would be as high as it turned out to be. In an attempt to meet that demand, CMS recently allotted an additional $35 million for the quality improvement organizations that are work-ing with facilities. However, the QIOs say that's only about a third of what they need to provide the help providers are seeking as the initiative, still in the pilot stage, nears the October national rollout date. "Large numbers of facilities have asked for assistance and cooperation and support from the QIOs - more, in fact, both in number and the intensity of services that they hope to receive through QIOs than CMS had budgeted for," David Schulke, executive vice president of the American Health Quality Association, said during an Aug. 1 conference call on the project. AHQA, which oversees the QIOs, and nursing home industry representatives approached CMS Administrator Tom Scully about the problem. In response, Scully moved the $35 million from support contracts and other QIO budget items to the QIOs' quality improvement work. "It's only about a third of the money that we need to really expand and meet the demand that nursing homes have come up with in response to the initiative, but it's a down payment," Schulke noted. "We think it's a very good sign." The QIOs operate on three-year contract cycles. In the current contract cycle, QIOs got about $100 million less than in the previous cycle, even though they're doing more work. Schulke reported that CMS currently is working to persuade the Office of Management and Budget to come up with the $65 million or so dollars to bring funding up to past levels. If the push for additional money fails, the QIOs will have to tailor the nursing home quality initiative to stretch their budget dollars as far as possible. "The nursing homes selected probably will be nearer to the QIO to cut down on travel costs," Schulke said. "It's possible that facilities that have more beds will be selected to have greater impact on a larger number of residents with the same expenditure of resources." The conference call took place a week after nursing home leaders, quality improvement experts, medical directors, state survey and certification officials, consumer advocates and nursing home ombudsmen met with CMS officials to evaluate the pilot state projects and discuss what's needed to make the national initiative successful. Held in Baltimore, the two-day conference - titled "Partnerships for Success: The Federal Initiative on Quality Improvementand Public Reporting in Nursing Facilities"- was co-sponsored by the American Association of Homes and Services for the Aging, the American Health Care Association and Rhode Island Quality Partners. The nursing home leaders who participated in the conference expressed optimism about the project. "I feel good about where I believe we are going with this," AHCA's Sandra Fitzler said during the conference call. "I do anticipate that there's going to be some pushes and pulls along the way, and we will need to be patient as we work these out. But the sooner and the smoother we deal with the issues, the better off we're all going to be."