CMS un­veils qual­ity ini­tia­tives

Modern Healthcare - - NEWS - By Vir­gil Dick­son and Sabriya Rice

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.