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LESSONS
FROM THE CMS DEMO ON NURSING HOME QUALITY MEASURES
As the Centers
for Medicare and Medicaid Services gears up for a national rollout of performance
data allowing consumers to compare the quality of care at local nursing homes,
industry, consumer, and quality improvement organizations say they're pleased
with a pilot that has been testing the use of the data.
"We're very
happy that there are a number of good success stories out there" from the
six-state demo, said David Schulke, executive director of the American Health
Quality Association. AHQA represents "Quality Improvement Organizations"
(QIOs) that worked in the demo to improve care at nursing homes that requested
their assistance after data on their performance was published in newspapers and
on the Web six months ago. Industry officials meanwhile said the pilot has helped
to refine the use of the performance data.
The national rollout
is scheduled for Nov. 12 with the posting of comparative data on the CMS "Nursing
Home Compare" web site. CMS plans to run ads Nov. 13 in 70 newspapers in
50 states publicizing how local homes compare on three of the measures. Publication
of the measures is meant in part to spur homes to improve their performance. They
can request direct help from a QIO to do so.
But the White House
Office of Management and Budget has held off on releasing $80 million that could
help QIOs assist many more than the small percentage of homes they were able to
help in the demo, said Schulke in a press briefing today. Schulke estimates that
while all nursing homes can get literature from QIOs on improving care, only 10
to 15 percent will be able to get more intensive direct help given limited QIO
funding. He said that 50 percent of the nursing homes in the six-state trial sought
direct help from QIOs. Schulke said he didn't know whether success stories about
quality improvement coming out of the demo would be possible merely by distributing
information.
Even as last-minute
preparations are made for the national rollout, it's not entirely clear that it
will go off as scheduled. Sen. Charles Grassley (R-IA) may request a delay in
the demo, a Grassley spokesperson said earlier this week. Apparently a General
Accounting Office study has raised questions about how easily consumers will be
able to understand the measures. The spokesperson said today that it's still unclear
whether Grassley will seek a delay. Schulke said that "everything we hear
from CMS is a go."
Industry officials
appear eager to get started. Sandra Fitzler of the American Health Care Association
told the press briefing that her organization has been encouraging providers to
educate consumers about the measures and that it has been working with CMS to
make sure consumers understand them. "We have to start someplace," added
Suzanne Weiss of the American Association of Homes and Services for the Aging.
Rolling out the measures will clarify further how consumers react to them and
speed the process of improving them, officials indicated.
Fitzler said that researchers during the pilot clarified that a weight-loss measure
it employed is not valid. The measure reported on the number of patients in a
home who lost weight during a given period of time. The measure won't be used
in the national rollout, Fitzler said. She said the pilot also clarified that
a measure of pain experienced by residents at a home did not mean the facility
lacked a good pain management program. A higher measure of pain might mean a home
is doing a better job of identifying patients in pain and recording that information,
she said. CMS will now be able to clarify that the measure is meant to trigger
discussion with the facility or with doctors.
Industry officials emphasized that the measures should be used only as one of
a variety of tools for picking a home and as a starting point for questions and
discussion. "This is not the perfect tool," said Weiss. The information
should not be used by itself, she said. It "is not a proxy for quality."
Carol Scott, president
of the National Association of State Long-Term Care Ombudsman Programs said she's
very much looking forward to next week. She said that the programs handle many
complaints about call lights not being answered and about patients not being treated
with dignity. Scott said she hopes these complaints will end with publication
of the measures.
Schulke said that
techniques are being explored to cope with QIO budget constraints. One is for
the organizations to work intensively with representatives of a number of homes,
and then to have them meet on their own with each other to share lessons learned.
Schulke hailed publication of the measures and subsequent quality improvement
efforts as "a major first step" in doing what the Institute of Medicine
has recommended in a report issued last week urging adoption and reporting of
standardized measures across federal health programs.
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