Although their admission rates seem to be unaffected so far, nursing homes in six pilot states are privately seething over quality measures released last month by the Centers for Medicare and Medicaid Services.
On April 24, the administration posted risk-adjusted data comparing nine quality-care measurements, such as the percentage of residents who lost too much weight and the percentage who had to be physically restrained, in each facility in the six pilot states-Colorado, Florida, Maryland, Ohio, Rhode Island and Washington-with the state averages (April 22, p. 12).
Much of the frustration has focused on an $11 million ad campaign by the CMS that used bar charts to show the percentage of residents in each facility who had bedsores, needed more daily activity or suffered from pain. The full-page ads ran in 30 newspapers in the six states and referred consumers to the CMS' Web site.
Nursing homes worried they would face an onslaught of questions from their communities. By most accounts, administrators received a manageable number of calls from residents' family members and sometimes a call from an admitting hospital. Although they were prepared to explain their ratings, nursing home leaders said the CMS quality initiative has put them in a tough position.
"It doesn't really measure quality in a nursing home," said Peter Van Runkle, president and chief executive officer of the Ohio Health Care Association, which has 800 members. "They mislead people when they say that is what these numbers do."
"They are using the wrong tool," said Lori Brothers, administrator of 72-bed Grandview Center in Cumberland, R.I. Grandview is owned by Genesis Health Ventures, Kennett Square, Pa. Brothers said families would be overwhelmed by the Web site information and would instead rely on the ads as a rating system.
CMS Administrator Thomas Scully, who has spearheaded the quality initiative, said he is not surprised that some nursing homes are privately complaining. "Anybody who doesn't look good is going to be unhappy," he said.
The data in the ads and on the Web site are designed to be only one tool to encourage consumers to inquire about nursing home care, he said. Scully admitted the CMS was wrong in one case when it printed incorrect numbers for a Cincinnati facility. The CMS plans to run a retraction in the local newspapers, and Scully will write a letter to the facility, he said.
"That is one out of thousands of them," Scully said. The data, which is updated every three months, is the best information available, he said.
But people associated with the nursing home industry still aren't convinced.
"The measures are misleading," said Washington state's long-term-care ombudsman, Kary Hyre. A Seattle-area facility he would not name scored well on the CMS quality measure for bedsores, but the same facility faces a potential lawsuit from family members of a resident who died in March from a bedsore, he said.
Hyre said he would prefer that the CMS list five-year trends on state surveys and consumer complaints.
In some cases, overzealous staff at the facilities gave the CMS wrong data. Brothers said she was surprised to see her facility had a 26% rate of bedsores, compared with the state average of 8%. It was a far cry from the facility's usual 4% rate of bedsores.
"An investigation showed staff members were marking rashes and other less significant skin disorders as bedsores," Brothers said. She has retrained her staff for the next round. "We weren't being fraudulent. It was wrong," she said.
At least one facility has issued statements to residents' families claiming the CMS is using the quality measures to reduce its Medicare payments because the best rating is 0%. "You don't need to be in a nursing home if you are at a zero," said Barbara Trimble, quality assurance administrator of the Briarwood in Stow, Ohio.
The 50-bed skilled-nursing facility operates a wound center, a hospice center and a rehabilitation department, which contributed to its high numbers, said Trimble, who also questioned the risk adjustments made by the CMS. According to the CMS data, 31% of the Briarwood's residents have bedsores, compared with the state's 9% average, and 51% of the Briarwood's long-term-care patients are in pain, compared with the 11% state average.
The American Health Care Association and the American Association of Homes and Services for the Aging support the CMS initiative.
Nursing homes should expect to see more scrutiny. Earlier this month, the CMS added results of nursing home investigations stemming from consumer complaints to survey investigation results already listed on its Web site.
Scully said he has heard little from nursing homes, but received 200 e-mails from consumers, and the Web site received 11,000 hits in the first week the data were released. "The fact is, the numbers are right," Scully said. "I have no doubt some of these nursing homes are quietly seething."