Long-Term Care Survey Alert

Will the national rollout of the nursing home quality initiative take into account your facilitys unique patient population? Thats an unanswered question that concerns many survey experts.

Its unknown at this time whether the quality measures will be risk adjusted for a facilitys casemix census, a specialist with the Centers for Medicare & Medicaid Services tells Eli. "That will be something everyone will debate, as there are different opinions," he says. "CMS has a national validation study we will be [unveiling] this July on whether you can accurately adjust for risk at the facility level."

The pilot quality measures are risk adjusted to some extent by excluding certain types of conditions that could inflate percentage scores, but they can be skewed by a facilitys admission profile.

Most of the quality measures used in the pilot look at prevalence of a certain resident outcome at a particular time. "A distressingly low three of the quality measures used in the pilot are incidence-based [where they compare residents to two points in time]," says Cheryl Field, director of clinical/reimbursement, LTCQ Inc. in Bedford, MA. "Those are improvement in walking, functional decline and weight loss."

The quality measure looking at weight loss is drawn from an MDS item that asks "yes or no" whether the resident lost 5 percent or more of body weight in the last 30 days or 10 percent or more in the last 180 days.

So the calculation doesnt look at the residents actual weight on one assessment and compare it to his weight on the next, although it does compare the residents status over time.

Likewise, most of the proposed measures for the national rollout capture prevalence of an outcome at a point in time. In addition to weight loss, functional decline and improvement in walking, the proposed post-acute measure of re-hospitalization would be considered an incidence measure, say survey experts.