Long-Term Care Survey Alert

-The whole is greater than the sum of its parts ... and CMS' internal long-term care task force plans to put that edict into action by "fully aligning" nursing home payment, quality and survey arenas. That's according to remarks by Thomas Hamilton, director of survey and certification for the Center for Medicaid and State Operations/ Survey and Certification Group at a recent SNF Open Door Forum.

CMS' ultimate goal is to promote optimal quality of care in nursing homes. And in pursuit of that ultimate goal, "surveyors can do an effective job of identifying problems in nursing homes - and they have the authority to see the problems are remedied," said Hamilton.

But that approach has its limits, Hamilton conceded, echoing what industry trade groups have been saying for decades.

"For example, if nursing homes try to solve a problem but find they need outside help, the state-run quality improvement organizations have a lot to offer," Hamilton said. "QIOs have been laboring in this vineyard for some time," he noted.

The question is how CMS can coordinate surveyors and QIOs to achieve the best results in improving quality of care. "Some definite firewalls between survey agencies and QIOs will be required, because QIOs require great candor and frankness from facilities to get to the root cause of problems," Hamilton emphasized.

CMS is also seeking collaboration from the nursing home industry as a stakeholder in the "alignment process," along with consumer advocacy groups.

CMS' effort will also focus on some "very discrete areas" where the agency sees tremendous potential for advancement, including reduction of - or prevention and treatment of - pressure sores, said Hamilton. "We are also looking at staffing issues as correlated to quality outcomes and additional examples of restraint reduction."

Other initiatives or ideas on the horizon: Pay for performance or incentives for providing quality care. Such a system would not be a "gotcha" situation, CMS representatives stressed during the ODF. CMS officials invite comments from individuals or entities willing to weigh in on models that might work. E-mail CMS staffer Sheila Lambowitz at slambowitz@cms.hhs.gov.
 
-CMS plans to do another staffing time study to inform updates to the SNF case-mix system. The current case mix approach relies on some data that's 15 years old, explained CMS' Sheila Lambowitz during a recent SNF Open Door Form. The agency plans to do the project in partnership with its stakeholders, including nursing home trade groups. "We also want input from state agencies, since over half of them use a variation to the RUG-III case-mix model for payment," Lambowitz noted. CMS plans to begin the study sometime this year.