What do you think about CMS publishing LTC facility QI's to the general public?

[jkw]

I have some issues with it being open to the public. As most of you know the MDS is very detailed w/ multiple questions to paint a full picture of the resident for that period of time. The QI reports only show a 6 month shot of the most recent assessment-some indicators hang in there for a long while-for example a sentinel event of low risk pressure ulcer. A resident may have had it for only 2 days but if it triggered during the mds period it will be on the report 3-6 months. I feel the general public will misunderstand the data-as we know there are certain contigencies why residents are triggered for particular QI's,and the general public won't have this knowledge-they will just see #'s. So what do you think? Jenna in KC MO.

[CaliNurse]

I have never thougth of it in this light. I work at a hospital that has a subacute LTC in it. We have to follow regs for acute and LTC. We actually look at our QI's all the time. We can explain due to the patient population why some of our quality indicators are flagged. We have never been questioned that I know of by the public about them. We are the only hospital in the city that I work in but there are several others in the same county. I guess it is possible that we could be viewed as "not perfect" by the public who views this information.

We actually try to teach the staff based on our quality indicators at each of our nursing staff meetings. With the staff being knowledgable in this area they can speak to anyone who asked them about it. They also pass out the printout of the current QI's each month.

And, yes - we know the surveyors are looking at this before they even come in the door. The know what is going on with each patient.

Cali

[VivaLasViejas, ASN, RN]

I just attended a day-long workshop on the new quality measures here in Oregon, and I've checked out several of our local facilities (including mine) on the Medicare nursing-home comparison site. The information is easy to understand for the LTC professional, not so easy for the average layperson, and while competition is the American way, I'm not sure I like this way of going about making nursing homes competitive. Some facilities have more deficiencies because of the types of residents they serve---more complex care means more minute details that can be missed, more paper work, more i's that need to be dotted and more t's that need to be crossed. I don't see how spending more time on paper work improves resident care; as a resident care manager, I already spend less than 10% of my time doing the actual hands-on care that keeps me in touch with what my residents need. If I don't get out on that floor and see, touch, hear, transfer, feed etc. I can't really do the MDS accurately, and if I don't do the MDS accurately, we don't get paid for the care we give. So now I'm supposed to spend even MORE time on paper.........If I could be sure an extra layer of bureaucracy would guarantee better quality care for my residents, I'd be more than happy to comply, but I'm afraid this is more about promoting a "customer service" atmosphere than providing nursing care to people in need of it. (That's a story for another day---I absolutely detest the customer-service approach to nursing. I didn't go through 4 years of college to become a glorified Wal-Mart greeter!!)

[eddy]

While I agree that people can take the info out of context, it is still very important to me that it is available. Why? Because while some facilities/units are unfairly judged the worste offenders are shown in all their glory. This helps to keep LTC's honest and more focused on quality measures. If John Q Public doesn't have readily available access to this sort of information, they have few means to make an educated decision on LTC's.

In my opinion it comes down to the almighty dollar. Administrators don't want to lose business, so they improve for next time. While it can hurt facilities that are trying very hard, it also protects us (general public) from making a poor decision. If this is what it takes, so be it.

More so than ever I support this being public info. See my recent post in Geri Care as to why I feel this way more than ever.

[renerian, BSN, RN]

I agree the public won't understand it. Heck sometimes we can't!!!!!!!!!LOL..

renerian

[eddy]

I would say that probably 2/3 of the problems can be attributed to poor staffing ratios. I have no loyalty to facilities, only the residents. If the facilities staff up, which may mean paying more than a living wage... grrrr (duh), then they will get the staff they need. Don't get caught up in the propaganda that these are not fair reflections... blah blah blah. Maybe they could be done in a more accurate way, but they are the only things that the public has to benchmark from, and without them people would be blindly entering into some pretty terrible places. The bottom line is that most facilities have staffing problems, and this is the true problem. Constant turnover, low staffing numbers (overworked employees), inadaquate orientations/training and poor management are what leads to negative reviews. In most cases it's not "if" you'll get bad marks it's "how many".

[probable cause]

QA/QI activity reports should remain confidential. Information gathering will be less than effective, as will the QA/QI program, if staff fear public disclosure.

[imperial]

Personally, I believe in public disclosure. However, I feel that public disclosure is part of consumer education. For example, the present CMS system of facility compare site often is not showing a clear picture of what has happened i.e. in words that one can understand who has no medical/healthcare background. I feel that instead of facility compare, having the survey results posted on a website could provide more information about a facility. Presently, to my knowledge, there are a few states that do such. One is PA but not sure of others. If we as healthcare professionals have nothing to worry about, why are we not for full disclosure.

[anniev]

amen eddy