Policy Government to release data on nursing home quality Last Updated: 2002-11-07 18:09:20 -0400 (Reuters Health) By Karen Pallarito NEW YORK (Reuters Health) - Federal health officials next week are expected to publish new data on the quality of care provided by the nation's nursing homes. It will mark the national launch of an unprecedented government effort to assist patients and families in choosing a nursing home. But critics are already questioning whether it will make a difference. Bush administration officials announced the initiative a year ago, following a string of scathing reports documenting serious lapses of care across the nation's nursing homes. The data will focus on key indicators of patient care, such as the percentage of residents with bed sores, in pain, in physical restraints or with some loss of ability to perform daily activities, such as feeding themselves and going to the bathroom alone. The measures are based on data reported by roughly 17,000 Medicare- and Medicaid-certified nursing homes. The Centers for Medicare and Medicaid Services, the agency charged with enforcing federal standards for patient health and safety and quality of care at nursing homes, will publish the quality measures in newspaper ads across the country next week and on Medicare's consumer Web site (www.medicare.gov). Officials hope the public exposure will goad nursing home facilities to improve care to some 2.9 million vulnerable seniors and disabled Americans. "The goal of this is for each individual nursing home to improve their quality," a CMS spokesman told Reuters Health. But some see it as little more than window dressing. "We don't think it will have any impact on the quality of care," said Steve Vancore, a spokesman for the Tampa, Florida-based law firm Wilkes & McHugh PA, which represents victims of nursing home abuse and neglect. "It's like, in lieu of doing actual improvements to the quality of care, we're going to report on it," he said of the CMS effort. With nursing home occupancy rates going up and available Medicaid beds going down, many seniors have little choice among providers, Vancore noted. Too few are accepting new patients and many are strapped for nurses to adequately care for the patients they have, he said. Vancore also pointed out that women 50 and older are generally the ones to decide where their loved ones will reside. They also represent a demographic group that is among the least likely to use the Internet. Nursing home advocates admit the information can be complex and difficult to wade through. But there is general agreement that it's a solid first step, providing a baseline for future measurement and improvement. "The real story is what happens after the data is up on the Web site and published," said Suzanne Weiss, senior vice president for advocacy at the American Association of Homes and Services for the Aging. "It's not a proxy for quality, but it should encourage consumers to ask questions," she said. Sandra Fitzler, director of clinical operations at the American Health Care Association, cautions that the measures are one of many tools for selecting a facility. "You really cannot look at those numbers and say, 'Aha, this is a really good facility and this is a really poor one,'" she said. As an example, a higher percentage of patients with very bad pain or moderate pain every day over a 7-day period might indicate that a nursing home is actually doing a better job than a rival facility, because it is measuring pain as a step toward a goal of creating a pain-free environment. As part of the initiative, CMS is offering technical assistance to nursing home facilities that need help identifying the causes of poor quality and resolving underlying problems. That help comes by way of a national network of quality improvement organizations, or QIOs, which contract with government and private organizations to improve patient care and safety. CMS recently completed a six-state pilot program to assess and refine the measures that will be part of the national rollout. Since the pilot's launch in April, 50% of nursing homes in those states have requested assistance. "The pilot showed that giving nursing homes technical assistance in quality improvement can and did result in rapid quality improvement," said David Schulke, executive vice president of the American Health Quality Association, which represents the nation's QIOs. But critics question whether the project will prod the nation's worst performers to rectify substandard care. "Facilities that are really not operating well at all have more fundamental problems to address...than the quality of care provided by these indicators," Schulke conceded. A certain "minimum level of readiness" is needed for a nursing home to move "from average to excellent," he said. A CMS spokesman could not say how much the government is investing in technical assistance. But Schulke acknowledged that it is not enough for QIOs to provide one-on-one assistance to even half of all nursing homes. It hopes to stretch its resources through electronic educational materials and conferences. Carol Scott, president of the National Association of Long-Term Care Ombudsman Programs, hopes the initiative will prompt consumers to ask questions and cause facilities to raise the level of care. Copyright © 2002 Reuters Limited. All rights reserved. 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