Nursing Home Quality Initiative by HHS

Nov. 13, 2002 – The Nursing Home Quality Initiative, aimed at improving the "quality of care given to the millions of Americans who live in nursing homes," was launched yesterday by U.S. Health and Human Services

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HHS Secretary Tommy G. Thompson today said the initiative combines new information for consumers about the quality of care provided in individual nursing homes with important resources available to nursing homes to improve the quality of care in their facilities.

"This is a new approach to bringing about better quality care in our nation's nursing homes," Secretary Thompson said. "Not only will consumers be better informed, but nursing homes themselves will be able to see more clearly what they must do to make the quality grade. They will have to compete in the quality arena. This is a major effort, and it will grow and improve over time, with improving data and new levels of collaboration to help nursing homes ensure high quality care."

The national launch follows the successful six-state pilot project, which involved nursing homes serving Medicare and Medicaid beneficiaries in Colorado, Florida, Maryland, Ohio, Rhode Island and Washington. The pilot project launched in April 2002.

"The pilot demonstrated that these measures aren't just good for consumers

-- they're good for nursing homes as well," said Secretary Thompson. "More than half of the nursing homes in the six pilot states requested technical assistance to help them improve their care and that is exactly the type of collaborative effort we envisioned -- and what we want to continue to see happen."

Today, HHS' Centers for Medicare & Medicaid Services (CMS) will publish advertisements in 71 newspapers in all 50 states that include a sampling of the quality data. The complete quality data, as well as "A Guide To Choosing A Nursing Home," are available at Medicare's consumer Web site, http://www.medicare.gov, and through Medicare's help line, 1-800-MEDICARE (1-800-633-4227).

HHS' National Nursing Home Quality Initiative is a four-pronged effort, consisting of:

q CMS' continuing regulatory and enforcement efforts conducted by state survey agencies;

q Improved consumer information on the quality of care in nursing homes;

q Continual community-based, quality improvement programs offered to nursing homes by Medicare's Quality Improvement Organizations (QIOs); and

q Collaboration and partnership to leverage knowledge and resources.

"We know nursing homes are just as interested in improving the high quality care they already give to their residents as we are," CMS administrator Tom Scully said. "By making this information available to the nursing homes and consumers, we are seeing a collaborative effort to do even more to raise the bar on quality."

To support CMS' evolutionary process of improving nursing home quality measures, a National Quality Forum (NQF) steering committee recommended domains of care for the public reporting pilot. NQF's nursing home steering committee included providers, state government representatives, consumer advocates, and others. For the national rollout, CMS made minor modifications to the list of measures, based on a comprehensive validation report and experience during the pilot.

The 10 quality measures fall into two categories -- six for chronic care patients (long-term stay residents) and four for post-acute care patients (short-term patients).

The six measures for long-stay residents are percentages of residents with :

q Loss of ability in basic daily activities,

q Infections,

q Pain,

q Pressure sores,

q Pressure sores (with additional facility level risk adjustment), and

q Physical restraints

The four measures for short-stay residents are percentages of short-stay residents with:

q Delirium,

q Delirium (with additional facility level risk adjustment),

q The ability to walk as well or better, and

q Pain

Another key component of the initiative is the assistance that every Quality Improvement Organization (QIO) has available to improve quality of care in local nursing home facilities. QIOs are CMS contractors that have offered improvement assistance to hospitals, physician offices, and, in some states nursing homes over the past decade. As part of the Quality Initiative, the QIOs are expanding their scope by providing information and consultation to skilled nursing facilities in all states.

In addition, QIOs and state and local long-term care ombudsmen will use the new data, along with other information and personal visits, to help families make informed decisions about placement in nursing homes. The ombudsmen are primarily volunteers who help nursing-home residents and their families on a daily basis and are trained and funded through HHS' Administration on Aging.