MEA­SUR­ING LTC per­for­mance

Nurs­ing home qual­ity mea­sures of­fer guide

Modern Healthcare - - Front Page - Paul Barr

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— medi­­pare—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

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