Nursing Home Oversight

1
Nursing Home Oversight

• Survey Activity
• 50 of the overall surveyors time is spent in
  nursing homes
• Routine Surveys
• Complaint Investigations
• Operation Spot Check

2
Nursing Home Pilot Project- Background

• New CMS initiative to publicly report a set of
  quality measures for all nursing homes in the US
• Initial pilot project to occur in six states
• CO, FL, MD, OH, RI, WA
• Dates
• April - September 2002 Six State Pilot
• National Rollout for all NHs Delayed until
  mid-November
• 2003 - Possible rollout into HHA, ESRD Hospital

3
Purpose of CMSs New Initiative

• Provide an additional data source to assist
  consumers decision making when selecting a
  nursing home
• Assist facilities to more effectively focus on
  quality improvement

4
Quality Improvement Organization Role in National
Initiative

• Assigned lead role in implementing the pilot
  project.
• Partner with state stakeholders, including AHCA,
  Ombudsmen, Advocates and Providers.
• Provide educational programs and materials to
  nursing homes in the state.
• Work with nursing homes that volunteer to
  implement quality improvement strategies based on
  the quality measures.

5
No Changes to State Survey Process

• State Survey Agency will still use the current
  CHSRA Quality Indicators as outlined in the
  survey process.
• Facilities will still have access to their CHSRA
  QIs and reports through the state system.
• The QIO does not participate in nursing home
  surveys.

6
Publicly Reported Quality Measures Utilized in
the Project

• Derived from MDS data only
• Risk adjusted to consider certain factors such as
  resident characteristics

7
Measures - Pilot

• Post acute pain management, walking improvement,
  delirium
• Chronic ADL decline, infections, pain
  management, pressure ulcers, restraints, weight
  loss

8
What is Risk Adjustment?

• Risk adjustment takes into account differences
  between residents so that QM scores can be
  compared between facilities in our state and in
  the nation.
• Risk adjustment is performed on the QMs through
  the use of statistical techniques.

9
Meaning of Adjusted Quality Measure

• In general, the lower the score the better the
  performance.
• Walking Improvement measure is the exception.
• Higher score for this measure is indicative of
  better performance.

10
Pilot vs. National Initiative

• The national rollout will include 10 measures
• Weight loss failed validity testing and was
  dropped after the pilot project was evaluated
• Facility Admission Profile will be included for
  certain measures

11
Measures - National Roll Out

• Post Acute Pain Management, Walking Improvement
  (FAP), Delirium (with w/o FAP)
• Chronic ADL Decline, Infections, Pain
  Management, Pressure Ulcers (with without FAP),
  Restraints

12
Questions???

• If providers have questions about the nursing
  home project, they should call 1-800-MEDICARE.
  CMS has committed to a twenty-four hour
  turnaround in response to these calls.

13
WEB Sites of Interest

• www.medicare.gov click on the Nursing Home
  Compare heading.
• Additional information on the background and
  purpose of the project can be found at
  www.cms.hhs.gov.