MEASURING LTC performance
Nursing home quality measures offer guide
The question of how to properly measure quality at nursing homes continues to vex an industry that has been dogged by accusations that its quality is poor. Revised nursing home quality measures that were endorsed in March by the National Quality Forum, a standards-setting organization, are expected to generally offer a better picture of nursing home quality, but some in the industry would like to see them changed and used differently.
Nicholas Castle, a professor with the University of Pittsburgh in its health policy and management department, said the NQF’s new measures are well designed and provide valuable information to both providers and consumers of nursing home care.
“I think they got most of the ones we in the research community like and use,” Castle said. Nobody likes to be rated on a report card, but providers should take some solace in the fact that the new measures are a good gauge of nursing home quality, Castle said. He particularly likes the addition of consumer-satisfaction measures, which are more easily understood by patients and their families.
The NQF endorsement carries weight because the CMS will include some of the measures in its public reporting and ratings website, Nursing Home Compare— medicare.gov/nhcompare—which includes star ratings for quality for individual nursing homes. And research indicates that consumers are increasingly using the Internet when choosing a nursing home.
Much of the reason for the NQF to introduce the new and revised measures was to conform to the federal government’s plans to change the minimum data set, or MDS, which is converting to version 3.0 from 2.0 to “improve the reliability, accuracy, and usefulness of the MDS, to include the resident in the assessment process, and to use standard pro- tocols used in other settings,” according to the CMS. In addition to adding consumer satisfaction measures, the NQF refined others.
The new nursing home measures are an improvement clinically and use better definitions, both of which should better represent the improving quality of care taking place in nursing homes, said Sandra Fitzler, senior director of clinical services for the American Health Care Association, a Washington-based nursing home group. “We are anticipating that the quality measures should show an improvement,” Fitzler said.
Ensuring that nursing homes are providing good quality care continues to be a hot-button issue. In October, Senate Finance Committee Chairman Max Baucus (D-Mont.), then- ranking member Chuck Grassley (R-Iowa) and Rep. Pete Stark (D-Calif.), at that time the chairman of the House Ways and Means Health Subcommittee, asked the Government Accountability Office to examine the relationship between for-profit nursing home providers and quality of care after receiving a GAO report indicating that large corporations are buying large numbers of nursing homes.
“This GAO report found that a handful of private-equity firms have been buying up nursing homes over the past decade—leaving seniors and their loved ones in the dark about who is making the decisions about their care,” Stark said in a news release. “New disclosure requirements in the healthreform law will shed light on who owns nursing homes, who is making care decisions, and how these facilities are being run.”
And a separate GAO report unveiled publicly last May found that state agencies charged with assessing nursing homes’ compliance with quality standards continue to miss serious care deficiencies that are sometimes later identified by the CMS. The report, released by Grassley and Sen. Herb Kohl (D-Wis.), noted that the disparity between federal surveys and state reports has decreased a little, indicating there is some improvement. But the report cautioned that understatements of deficiencies by state inspectors are still a rampant problem.
“The gap between state inspectors and federal inspectors is shrinking, but not fast enough,” Grassley said in a news release.
The 21 new measures unveiled March 3 by the NQF reflect a variety of matters related to the types of care provided, current health status and changes in health status and patient and family satisfaction. The NQF declined comment for this story.
Of the new measures, four relate to flu and pneumonia vaccines, while pain, consumer satisfaction and bladder/urinary tract/bowels each have three measures. Two measures relate to pressure ulcers, while patient falls, restraints, help needed for daily living, weight loss, depression and physical therapy or rehabilitation care each have one new measure.
The measures also can be grouped by the length of stay, which is important because short-stay residents—defined by the NQF as resident stays of 100 days or fewer—tend to