Medicare Compliance & Reimbursement

SNFs must prepare for a proposed link between payment and QI data. If a skilled nursing facility's quality improvement efforts aren't top notch, chances are it's already paying for it: Studies show high-quality care costs less to provide. But providers are likely to have even more financial incentive to hone their quality improvement skills in the future. A pilot project announced early in July by the Bush Administration links payment and quality for hospitals - and now the Association of Homes and Services for the Aging has told federal lawmakers it would embrace a similar approach for nursing homes. Under the hospital pilot program, the Centers for Medicare & Medicaid Services will post hospitals' quality report cards on the Internet. In its next step, the agency will attempt to recalibrate the entire Medicare payment structure to one that rewards performances, CMS says. Though there's no direct link now between quality measures and reimbursement, long-term care providers would be wise to invest time and money in a quality improvement program that goes above and beyond existing federal regulations, says Patricia Gafney, a licensed nursing home administrator and nurse consultant with Joanne Wilson's Gerontological Nursing Ventures in Laurel, MD.

"The stronger the QI program, the better success providers have in improving outcomes and lowering risk for survey citations and litigation," she asserts. Here's how SNFs can take their program to the next level: Use MDS software to track data. Many MDS programs already allow SNFs to track and analyze quality improvement data electronically, a function that the MDS coordinator may miss. Meet more often. Though federal regulations call for quality assurance meetings quarterly, Gafney suggests monthly meetings interspersed with weekly gatherings by subcommittees charged with falls, wound care and other common concerns. Make it interdisciplinary. Invite the participation of not only clinicians but also direct caregivers, housekeeping staff, social workers and dietary personnel, advises Gafney. Buy-in is vital. "Too often, the recommendations from the quality assurance manager end up in some drawer," Gafney notes. Tap the local quality improvement organization. Taking part in the federally funded QIO program is voluntary, but nursing facilities in all states have access to the assistance of the group in their state, notes Kathy Tuozzo, project manager with Qualidigm, Connecticut's QIO. QIOs, formerly known as peer review organizations, provide assistance to nursing homes by furnishing education programs on quality improvement, identifying improvement opportunities, and sharing valuable resources and best practices.