CMS unveils quality initiatives
The Obama administration took two major steps last week to improve the quality of long-term care.
The CMS proposed rules to enhance quality for an estimated 1.5 million Medicare and Medicaid beneficiaries receiving care at more than 15,000 nursing homes and other facilities. The rules include measures to reduce preventable hospital readmissions and infections.
The agency also released a new fivestar quality-rating report on 9,359 home health agencies. Only 239 agencies received the highest rating of five stars; 201 got either one or 1.5 stars; and 4,274 got three stars.
President Barack Obama announced the new nursing home rules last week at the White House Conference on Aging. The rules would require facilities to train staff in caring for residents with dementia and preventing elder abuse.
Other changes include improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of caregivers’ capacity; giving residents information they need for follow-up; and ensuring that instructions are transmitted to receiving facilities.
The CMS also wants to strengthen nursing home residents’ rights, including placing limits on when and how nursing homes can require residents and their families to sign binding arbitration agreements prior to admission. Comments on the rule are due Sept. 16.
The Long Term Care Community Coalition, a resident advocacy group, said it’s happy to see the administration take steps to improve care, but it was disappointed the agency didn’t push for mandatory staffing minimums and tougher controls on the use of anti-psychotics.
The American Health Care Association, which represents nursing homes, criticized the rules on the grounds that they would drive up costs. The CMS said the rules would cost the nursing home industry $729 million in the first year and $638 million in year two.
“We would oppose such a large unfunded mandate, especially given the overall narrow margins of 1% to 3% ... for skilled-nursing-care centers,” said Dr. David Gifford, the group’s senior vice president of quality and regulatory affairs.
On the home health star ratings, the National Association for Home Health & Hospice expressed concerns about the methodology, which allows only a certain percentage of facilities into each star-rating category.
The group also expressed concern about measures they say do not truly reflect the needs of the population being served.
Each home health agency received a summary star rating based on its performance on nine out of nearly 30 quality measures already posted on Home Health Compare, the CMS’ consumer-facing comparison tool.
The summary rating is based on providers’ outcomes for three process measures and six outcome measures. On average, providers nationwide scored higher on processes than on outcomes.
The process measures include the timely initiation of care; education provided to patients or their caregivers about medications; and the administration of flu shots.
The national average for achieving those measures was 91.7%, 92.8% and 72.8% respectively, according to the CMS data.
Percentages were lower in terms of how often patients improved on certain measures. They saw improvements getting in and out of bed 58.6% of the time; walking or moving, 63.1%; breathing, 65%; feeling less pain when moving around, 67.9%; and bathing, 68.2%. Home health patients had to be admitted to the hospital 15.8% of the time. The CMS says star ratings can help consumers select a provider based on quality. The agency has used a similar system to rate nursing homes since 2008. Star ratings were expanded to physician groups last year and to dialysis facilities this year.