On the heels of HHS posting quality measurements on its Web site and after more than a dozen Senate hearings on long-term-care fraud and abuse, leaders of three nursing home associations last week signed a voluntary covenant that maps a plan to promote quality and better their reputations.
The American Association of Homes and Services for the Aging, the American Health Care Association and the Alliance for Quality Nursing Home Care, which collectively represent more than 17,000 for-profit and not-for-profit nursing homes nationwide, agreed at a ceremony at the National Press Club in Washington to seven principles they said would improve quality, public disclosure and financial stewardship by 2006.
"I believe we are committed as three associations to changing long-term care in this nation," said Larry Minnix Jr., president and chief executive officer of the AAHSA, which represents not-for-profit nursing homes. The initiative may become a condition of association membership in the future, he said.
While the covenant is encouraging, mere commitment won't be enough, said Stephen Cooper, a Washington healthcare lobbyist with FH/GPC, a subsidiary of Fleishman-Hillard. "Unless the industry will agree to penalties and sanctions, it's not going to work," said Cooper, who served as a senior official with the New York State Department of Health from 1974 to 1984.
The covenant also could face pressure because it is overseen by associations. "You have to be careful they will not move toward the lowest common denominator to keep membership," Cooper said.
Nursing home leaders said they are dedicated to quality improvements. "Not meeting them is unthinkable-we've got to do this," said Charles Roadman II, M.D., president and CEO of the AHCA, which represents mostly for-profit nursing homes.
The covenant outlines seven core principles-ethical practice; financial stewardship; patient and family rights; public disclosure and accountability; public comment; quality improvement and assurance; and workforce excellence. Each of the three associations has outlined separate plans tailored to its members to meet the goals.
Consumer groups said they support the initiative but warned they will be monitoring it closely.
"Promises are one thing, performance is another," said John Rother, director of policy and strategy for the AARP, formerly known as the American Association of Retired Persons. "We're here to hold this industry accountable."
In the next few months, the nursing homes plan to name an unknown number of members to an independent commission that will report industry progress based on the covenant to both HHS and Congress. Details are being worked out, but the commission will not have enforcement authority.
The quality effort follows 13 hearings by the Senate Special Committee on Aging that prompted its chairman, Sen. John Breaux (D-La.), to tell the industry to make improvements. It also comes three months after HHS began publishing quality measurements for individual facilities in six states-an initiative it plans to take nationwide later this year. While working with the Centers for Medicare and Medicaid Services, the three associations realized they each were trying to create similar guidelines.
The effort will do more than the CMS initiative, which lists quality data for facilities but does not identify ways to improve, said Michael Walker, chairman of Genesis Health Ventures, Kennett Square, Pa., and chairman of the alliance, which represents 14 for-profit providers.
The effort won the support of the Bush administration, which has encouraged public-private partnerships in its approach to governing business. HHS Secretary Tommy Thompson showed up at the ceremony despite scheduling conflicts, declaring it a red-letter day.
The department can regulate, but it can't achieve results unless the industry buys into the initiative, Thompson said. "Here are three associations saying we can do better," he said. "We are going to work with them to improve their services."
Other health providers might want to take note. Hospitals would be the next to improve quality measures if CMS Administrator Thomas Scully had his way. "This is a model for what consumers want," Scully said.
In a related development, the National Quality Forum last week released its national framework for quality measurement and reporting. The statement of 17 principles, policies and strategic focuses for current and future quality improvement efforts represents a consensus among 150 major stakeholder groups. The framework formally sets down the policy that all agencies and organizations requesting data on healthcare processes and outcomes "commit to reducing the burden of reporting by eliminating redundancy in information collection efforts," according to a copy of the report first obtained July 15 by Modern Healthcare's Daily Dose.
-With John Morrissey