Long-Term Care Survey Alert

Call it government oversight meets private sector QI.
 
The Joint Commission on Accreditation of Healthcare Organizations plans to approach Congress this year about doing a demonstration project with the Centers for Medicare & Medicaid Services with an overall goal of improving nursing home quality of care. "We want to see if there's some synergy between what government enforcement and private sector quality improvement techniques can bring to the table," explains Margaret Van Amringe, vice president of external relations for JCAHO. 
 
JCAHO's new efforts reflect a growing sense that government oversight isn't the entire answer to quality improvement in nursing homes, Van Amringe notes. "Government agencies and regulators have tried to do their work alone in improving nursing home quality, and their efforts have helped," she says. "But CMS has repeatedly said surveyors are not there to partner with facilities or educate them about quality practices. Surveyors are there to review care and ferret out deficiencies.
 
"Facilities are operating in a resource constrained environment," Amringe adds. "So what is the sense in continuing to cite the same problems, if you don't help facilities correct them?"
 
"If the punitive approach to compliance and quality of care was going to work, it would have done so a long time ago," agrees Tim Graves, president of the Texas Health Care Association (TAHCA), which was instrumental in getting Texas to pass legislation paving the way for a pilot project that would allow a group of Medicaid nursing facilities to use JCAHO as its survey agency. Graves maintains that the oversight system should include mechanisms to help nursing homes avoid problems - and lend a hand to facilities that appear to have the same recurrent problems.
 
Many industry leaders have long asked CMS to put more energy into identifying and helping the chronic poor performers. "Putting every facility in the same basket sends the wrong message to the public," says former Ohio survey bureau chief Kurt Haas, now a consultant in Lithopolis, OH.