Five months after announcing its healthcare quality initiative campaign, HHS will unveil how individual nursing homes in six states rate when treating residents, making the information available to the facilities-and anyone else who cares to know.
HHS Secretary Tommy Thompson is scheduled to release data April 24 on 2,566 nursing homes in the pilot states of Colorado, Florida, Maryland, Ohio, Rhode Island and Washington.
The Centers for Medicare and Medicaid Services is slated to run ads in 30 newspapers in those states the next day. The full-page ads will compare local nursing homes and give the state's average based on three quality measurements: the percentage of residents who have bedsores, the percentage who need help with daily activities and the percentage who are in pain.
The CMS Web site-www.cms.gov-will list four other indicators that measure how many long-term residents lost too much weight, how many have infections, how many are physically restrained and how many have improved their walking ability. It also will list the percentage of short-term residents who suffer from pain and delirium.
CMS Administrator Thomas Scully said the initiative not only will improve the overall quality of nursing homes, which he called miserable, but also will serve to improve the negative public perception that recently has dogged nursing homes by letting people know when a nursing home does well.
"Some nursing homes are going to look good, and some will look bad. That's the design. I don't expect everyone to be happy with it," Scully said.
Nursing homes in the pilot states have expected their quality data to go public since HHS announced the initiative last November (Nov. 26, 2001, p. 6). The agency plans to roll out a national quality initiative for nursing homes in October and to eventually include other healthcare providers such as home health agencies and hospitals.
The broader nursing home quality initiative could look very different from the demonstration project, however.
"The whole point of a pilot is to test it," Scully said. "I have no doubt there will be changes as we go along."
For the pilot, the CMS adopted only nine of 11 quality measures recommended by the steering committee for the National Quality Forum, a public-private partnership charged with developing a national strategy for healthcare quality reporting. The CMS will take into consideration risk adjustments to make sure there are no disincentives for nursing homes to admit a patient. For example, the data excludes for 90 days residents who were admitted with bedsores.
Last week, the forum proposed 13 quality measures for the national nursing home quality initiative. Its 140 member organizations will vote on the standards in May.
Nursing home groups support the overall quality initiative but continue to work closely with the CMS, monitoring the fine points.
Charles Roadman II, M.D., chief executive officer and president of the American Health Care Association, which represents mostly for-profit facilities, said he approached the quality initiative with cautious optimism. "I think we argue over details rather than the larger process of going ahead and getting outcome measures that we can follow over time and watch improvement across the system," he said.
Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, which represents not-for-profit facilities, supports the overall initiative, but he admitted it would be hard for the facilities in the six states.
"It will cause difficulties in the front end," he said. "These nursing homes in the demonstration are in the front lines of Normandy, but there isn't any question we've got to get to the Rhine."
Consumer groups have criticized the initiative. Although it will make people aware of the differences in quality offered by nursing homes, it doesn't help them make choices under time and emotional pressures, said David Lansky, president of the Portland, Ore.-based Foundation for Accountability.
The quality initiative is only one tool for consumers, Scully countered. The ads will advise readers to visit the CMS Web site or call Medicare's toll-free number for greater detail. Every three months, the site will be updated with quality data from the previous quarter.
Scully said he wants the initiative to spur consumers to ask nursing homes about quality.
The staff at the Clear Creek Care Center, a privately owned, 118-bed nursing home in Westminster, Colo., is prepared if they do, said nursing home Administrator Beth Irtz, a registered nurse. The facility told residents' families about the quality initiative in its April newsletter and has encouraged calls.
"For the consumer, the quality measure needs more discussion at the facility level," Irtz said.
The facility has tracked its own quality indicators each month, but the pilot project lets Clear Creek see how it compares with other facilities in the state, she said.
Based on the most recent quality data from the CMS, which Irtz said she expected would be published in the upcoming ads, her staff is prepared to explain why 15% of Clear Creek's patients have physical restraints, compared with the state average of 7%. Some older patients suffer from seizures and some younger patients suffer from closed head injuries. They can't sit in a wheelchair without a soft seat belt, Irtz said.
Clear Creek will be able to show it does better than the state average in two areas. Only 12% of its patients need more daily activities, compared with the 16% state average, and 19% of Clear Creek residents suffer from pain, compared with the state average of 20%.
At this point, Irtz said she does not know if Clear Creek will be one of the 10% of nursing homes nationally chosen to work with the quality-improvement organizations, formerly known as peer-review organizations.
"We wish they would be matched up with more facilities," Irtz said. Until then, best practices will have to do, she said.
The QIOs, on the other hand, fear they will be overwhelmed by their work with state ombudsmen and others in the nursing home community, said David Schulke, executive vice president of the American Health Quality Association, which represents the QIOs.
That is fine with Scully. "If it turns out there is a problem, we'll get more money for them," he said. "I'm trying to make them really focus on quality."