Six months after launching its pilot initiative for measuring nursing home quality, the Centers for Medicare and Medicaid Services plans to roll out the program nationwide this week with the hope that additional public information on facilities will improve the quality of care.
In November 2001, HHS Secretary Tommy Thompson introduced his Nursing Home Quality Initiative to signal a new emphasis by the CMS on quality improvement in skilled-nursing care. The initiative identified eight measures generally associated with indications of the quality of care nursing homes provide, including rates of pain and bedsores. As part of the initiative, federal health officials contracted with state quality-improvement organizations to assist nursing homes with enhancing quality in their facilities.
The six-state pilot program was introduced in Colorado, Florida, Maryland, Ohio, Rhode Island and Washington in April, and consumers were invited to log onto the CMS' Web site to view the quality measures for every nursing home located in those states.
"The federal government's biggest business is healthcare and it's the one place in our economy where there's the least amount of consumer information," CMS Administrator Thomas Scully said earlier this month at a Washington conference on senior housing and care sponsored by the National Investment Center. "I've always felt the lack of information in healthcare about quality has been outrageous."
David Schulke, executive vice president of the American Health Quality Association, said the CMS' national rollout exemplifies reforms recommended last month by the Institute of Medicine, which called for federal officials to standardize quality measures and report to the public on the quality of care delivered by individual providers (Nov. 4, p. 6).
"This initiative is a big step in that direction," Schulke said in a written statement. "It will significantly improve nursing home care."
Close partnerships with the national network of QIOs are key to addressing quality issues because many nursing homes need help identifying and resolving the root causes of quality problems, he said. Since the program began last April, half of all nursing homes in the pilot states have requested QIO assistance to redesign clinical systems with a focus on better pain management, treatment of pressure ulcers, immunizations, and treatment for chronic diseases and conditions. Many have joined intensive technical-assistance programs or attended workshops conducted by QIOs, Schulke said.
"The vast majority of homes that worked with QIOs in the pilot states have made fundamental improvements in their processes for managing pain," he said.
The American Association of Homes and Services for the Aging, Washington, which represents 5,600 not-for-profit nursing homes, said as new care options have emerged for healthier seniors, more nursing home providers are finding themselves caring for the frailest of seniors who require around-the-clock skilled care.
Some nursing homes already have developed in-house quality reporting initiatives independent of the CMS.
For example, a monthly report card offering statistical data that translates to "grades" on a wide variety of health and safety issues is provided to board members, staff and administrators at Jewish Home and Hospital, New York, which has 1,640 beds among its three campuses.
"Our board isn't so excited about the CMS data, but they're very used to it and they understand there may be implications," said Audrey Weiner, president and chief executive officer of Jewish Home and Hospital Lifecare System. "They know the consequence is going to look like we have patients who developed ulcers, but that's because we take in patients with ulcers from hospitals. Our board knows they can be proud of the care we provide, even though we may not be at the national norms."