The American Health Care Association announced eight new priorities with specific timelines to address nursing homes' performance on problems such as 30-day readmission rates, antipsychotic drug overuse and high rates of staff turnover.
Dogged by accusations over poor quality, the nursing home industry has been making concerted efforts to drive improvements over the past few years. The new updates align with federal efforts to tie reimbursements to value and strengthen measures used to rate nursing homes, AHCA leaders said.
“We are not aspiring to adjectives; we are aspiring to specific numbers and specific times,” CEO Mark Parkinson said. “There is still good progress that can be made that can safely reduce the numbers and improve residents' lives.”
The not-for-profit association represents more than 11,000 U.S. facilities that care for the elderly and disabled. It issued a first set of nursing home quality priorities in 2012 that the organization aimed to achieve by March 2015.
The eight new goals for ACHA members include three goals to be achieved by all members by March 2018: maintaining a staff turnover rate at 40% or less; having at least 25% of members report on measures of patient satisfaction; and reducing infections and other unintended outcomes.
For members running short-term and post-acute-care facilities, the goals for spring 2018 are reducing 30-day readmission rates by an additional 15% (a total of 30% since 2012) and having at least 25% of members report on functional outcome measures using a specified Web tool for benchmarking metrics.
And for long-term stay and dementia-care facilities, the group set a goal of reducing the off-label use of antipsychotics by 10% by the end of this year and 15% by the end of 2016. It also aims to reduce hospitalizations among long-term residents by 15% by March 2018.
The federal government has been strengthening its focus on nursing home safety in the wake of published reports identifying facilities with known quality problems that nevertheless received high marks under the CMS' five-star rating system.
HHS' inspector general's office, meanwhile, estimated in a report last year that 22% of patients at skilled-nursing facilities experienced preventable injuries, such as medication errors, falls and infections, and spent more time hospitalized as a result.
In February, the CMS announced plans to make it more difficult for nursing homes to get five stars on its rating system.
The agency said it “raised the bar for performance” by adding two new quality measures related to the reduction of antipsychotic drug use in patients who do not have schizophrenia, Huntington's disease or Tourette syndrome. It also expanded on-site surveys and implemented use of an electronic reporting system to verify staffing levels.
Dr. David Gifford, AHCA's senior vice president for quality and regulatory affairs, said Thursday that the updated priorities and timelines are aligned with federal goals focused on value-based care, including the Impact Act, a bill aimed at modernizing Medicare's payments to post-acute-care providers.
He also noted that Medicare included tweaks to the long-term-care quality reporting program in the draft rule for the Hospital Inpatient Prospective Payment Systems released last month.
Since setting priorities for members in 2012, the association says it has seen a 21.2% decrease in misuse of antipsychotics and a 14.2% reduction in readmissions, together benefiting more than 73,000 patients.
“It's easy to talk in terms of percentages … but these are real lives,” Parkinson said. “This is a real effort with significant goals that if we achieve will materially improve people's lives.”
