Long-Term Care Survey Alert

The Centers for Medicare & Medicaid Services rolled out the Nursing Home Quality Initiative on Nov. 12 with a press conference touting the effort as the first leg in a national quality system that will eventually encompass home health and hospitals. On the same day, CMS also posted quality measure performance scores on its Nursing Home Compare Web site for virtually every nursing facility in the nation.

Long-term care trade group leaders joined CMS Administrator Tom Scully at the podium in a show of support for the initiative, lauding the opportunity for quality improvement. "Facilities that refuse to do better will be driven out of the business," emphasized Larry Minnix, chief executive officer of the American Association of Homes & Services for the Aging.

According to Scully, 78 percent of nursing facilities in the six states where CMS tested the quality initiative this year made improvements, either on their own or with the help of quality improvement organizations. CMS has tapped the QIOs to provide technical assistance and other resources to facilities as a key component of the NHQI.

Participants in the CMS conference expressed concern, however, about funding levels for the QIOs. While these state-run agencies will provide information to all nursing facilities through conferences, mailings and peer-group collaborations, they will only have enough money to work intensively with about 10 to 15 percent of SNFs in each state. Yet about 50 percent of facilities in the pilot initiative reportedly requested intensive assistance from the QIOs.

"The QIOs would like to be able to say that every nursing home that wants support will get it," reported geriatrician David Gifford, with the Rhode Island QIO, "but we're not quite there yet." Gifford noted that the QIO budget is $70 to $80 million less than last year's contract in spite of the greater demands imposed by the NHQI. "The assistance QIOs will provide will be good, though," Gifford promised.

Scully reported that CMS is pressuring the White House Office of Management & Budget for funding in addition to the $350 million that already goes to QIOs each year to ensure adequate resources for the NHQI. The OMB has reportedly been reluctant to release the extra funding due to concerns about QIO performance in the past and some skepticism about the NHQI.

CMS and industry representatives also emphasized that the initiative is a "work in progress." For example, American Health Care Association chief Charles Roadman said providers would like to see CMS post information in a couple of years explaining what a nursing facility is doing to prevent and heal pressure ulcers not just the prevalence of residents with this outcome.