Long-Term Care Survey Alert

Published on Fri Aug 28, 2009 PDF

Customer satisfaction, rehab, rehospitalization, and more are on the agenda.

If your facility's star rating isn't as bright as you'd like, take heart. The Five-Star nursing home quality rating program may eventually include a number of new quality measures to better illuminate a facility's true quality profile. The Centers for Medicare & Medicaid Services has received general feedback on the importance of developing more quality measures so that "more aspects of quality are measured," reported Thomas Hamilton, director of the Survey and Certification Group for the Center for Medicaid & State Operations in a July SNF/LTC Open Door Forum. "That's particularly true with regard to the short-stay measures," Hamilton noted.

CMS calculates each facility's star rating based on a subset of quality measures, as well as staffing data, and survey performance.  Providers and associations have also noted the need for more risk adjustments for the QMs, a request that CMS is looking at doing.

Example: One provider in a short-term facility specializing in rehab called in to lament that the facility's quality measure on pain runs very high due to caring for people with broken hips, and the like. Yet, there's no way to indicate on the existing quality measure that the facility has a good pain management program, the caller said.

In the QM arena, CMS is looking at resident and family feedback and satisfaction surveys. So far, the agency has "identified at least three levels of involvement in that area," Hamilton reported. One possibility would be for CMS to report on Nursing Home Compare whether or not a nursing home uses a consumer and family feedback system. The next step up would be to develop criteria characteristic of effective resident and family feedback systems, and then identify which facilities meet those criteria, Hamilton added.

"Probably the next step up from that" would be a single, national feedback system objectively administered by a third party, Hamilton continued.  CMS plans on talking with stakeholders about these various approaches, including the pros and cons, and costs involved.

Watch for rehab: As for other potential quality measures, certainly rehabilitative care is one on our radar screen, Hamilton relayed. CMS is, in fact, looking at a number of potential rehab measures, added the agency's Ed Mortimer. Hospital readmission as a potential quality measure is also near the top of the list, he added. And "community discharge is another one" on the other end of the continuum. CMS' efforts to improve the Five-Star program represent a positive step, most industry insiders concede, although the public rating system remains controversial. "The quality measures currently used for nursing homes are both limited and fall short in measuring all common quality outcomes," says Bruce Yarwood, president and CEO of the American Health Care Association. "For example, there are no measures for special care populations like Alzheimer's patients," Yarwood tells Eli. "Any new measures will need to be tested before release and monitored to ensure outcomes are valid and reliable."