Quality Initiatives for Healthcare

[Youda]

http://www.kansascity.com/mld/kansascity/news/local/4478220.htm

Agency releasing data to help consumers compare nursing homes

By ALAN BAVLEY

The Kansas City Star

The federal agency that runs Medicare is giving consumers some help with the daunting task of finding a nursing home with quality care.

Beginning Tuesday, the Centers for Medicare and Medicaid Services is opening a trove of data that directly compare how patients fare at 17,000 nursing homes nationwide.

Consumers will be able to see, for example, the percentage of patients at each nursing home who suffer from pressure sores or infections, who experience severe pain, who lose the ability to perform basic tasks such as feeding themselves, or who are held in physical restraints.

In all, 10 such comparative quality measures will be given, along with state averages for each of the measures.

The information will be available over the phone by calling (800) MEDICARE (633-4227) and at Medicare's Web site, http://www.medicare.gov.

"It's a good thing to be doing for the public. I'm absolutely convinced about that," said Joe Tilghman, Kansas City regional administrator for the Centers for Medicare and Medicaid Services.

Consumers have plenty of places where they can find ratings of products from cars to vacuum cleaners, Tilghman said. "But there isn't much for health care."

The Centers for Medicare and Medicaid Services plans to roll out its Nursing Home Quality Initiative on Tuesday with a press conference in Washington, visits by government officials to morning talk shows and with local media events across the country. The agency also is expected to place advertisements in about 70 newspapers nationwide that will feature some of the data on local nursing homes.

The complete set of data should appear on the Medicare Web site on Tuesday.

The federal initiative is intended not only to provide consumers with information but also to motivate nursing homes to improve, Tilghman said. A similar project measuring the quality of home health agencies could be launched next year, he said, and one for hospitals sometime later.

So far, the initiative has received guarded support from the nursing home industry, which sees the measures as an imperfect indication of the quality of nursing home care.

"The measurements are only tools... they don't tell the whole story," said Sandra Fitzler, director of clinical operations for the American Health Care Association, a trade organization for nursing homes.

"You can't look at the numbers and say, `Aha, that's a really good nursing home and that's a really poor one.' "

Consumers looking for a nursing home shouldn't rely on these measures alone, said Suzanne Weiss, senior vice president of the American Association of Homes and Services for the Aging, which represents nonprofit nursing homes.

Weiss said people shopping for a nursing home should visit the homes they are considering, review the staff and the programs offered and seek the advice of their physicians.

The new quality measures "should encourage consumers to ask questions and the more questions they ask, the more information they will have," she said.

While the federal agency is keeping a tight lid on the data until the formal release, Donna Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform, expects the information will reveal that many homes have serious problems.

"I think it will show poor quality of care at many nursing homes, shocking numbers of cases of people with untreated pain or pressure ulcers. These aren't just little sores, they're life threatening."

Lenhoff said she wants the federal agency to add quality measures, such as the number of staff caring for patients and whether patients lost excessive weight.

Data for the measures come from lengthy surveys that nursing homes have for many years been required to fill out periodically on every patient. The data are collected by each state and sent to a national database. Because new information is regularly available, the Centers for Medicare and Medicaid Services will update the nursing home measures quarterly.

To help nursing homes improve their care, private agencies under contract to the centers in each state will serve as consultants to homes that ask for assistance. These state quality improvement organizations have been working for decades to improve care at hospitals and doctors' offices, but historically have done relatively little with nursing homes.

"We'll be able to offer them far more technical assistance than we have in the past," said Lisa Williams, spokeswoman for the Kansas Foundation for Medical Care, the state's quality improvement organization. "This is a new opportunity for the nursing home industry to use us as a resource."

A six-state pilot nursing home project that ran from April through October suggests that many nursing homes will be seeking help. More than half the nursing homes in the six pilot states asked for assistance from their quality improvement organizations. And more than three-fourths of nursing homes reported making efforts to improve their quality of care.

[baseline]

I h ave a friend who is an MDS coordinator in Fla....I definetly need to give here a call tomorrow about this one!

[Youda]

Unfortunately, the last LTC I worked in started playing with the data, because they knew this was coming. For example, they said that we could no longer stage decubs, because we were suddenly not qualified to say it's a stage I, II, or IV. Another trick was to change all the diagnoses so that no psychotropics were given for psych problems, but only for a dx that did not trigger anything on the MDS's. They also put everyone on PRN pain meds on routine pain meds so they could say the res. didn't have any pain (nevermind that they were zonked or getting meds they didn't need), so it wouldn't trigger the MDS. On and on. This is a good step, but already the corporations are figuring out ways to fill-out the MDS's so it doesn't trigger any of the parameters for the Qualty Initiative.

[NRSKarenRN, BSN, RN]

Info also available at:

http://www.healthgrade.com for hospitals, nursing homes and Home Health Agencies.

http://www.seniorcarehelp.com/ Nursing Home Report

Cards from SeniorCare Resources---detail reports for a fee

(have cheked snaoshot---similar state released info, no experience with paid info/reliability.

[WashYaHands]

Youda,

Thanks for posting the article. When I read it I thought, "what a good initiative, good for consumers, good for patients". It's sad that your LTC manipulated the data to get around complying. Reminded me of a saying, "There are lies, damn lies, and statistics". Again, thanks for posting it.

Linda