Clare B. Bradley MD, MPH, Senior Vice President/Chief Medical Officer of IPRO said the "Nursing Home Quality Improvement" program recently launched by the federal Centers for Medicare & Medicaid Services (CMS) empowers consumers while providing nursing home administrators with specific goals for improving their facilities.
IPRO is one of more than 50 Medicare "Quality Improvement Organizations" located in each state as well as in Puerto Rico, the Virgin Islands and Washington, D.C. Under contract with CMS, these private, nonprofit corporations have assisted doctors' offices and hospitals for several years to improve the quality of their services to Medicare beneficiaries. They also promote preventive services covered by Medicare, such as flu shots, pneumonia shots and mammograms. These "QIOs," as they are called by those who work for them, provide quality improvement consulting, measurement, training in best practices and evaluation at no cost to health care providers, which now include nursing homes.
A key element in the new nursing home quality initiative is a set of nursing home quality measures that CMS has compiled and has made available to the public for the first time. Consumers who have computers can log on to www.medicare.gov. They can then click on "Nursing Home Compare" to access and compare new quality measures of their loved one's nursing home with other facilities in the area. Those who don't have access to a computer can use a toll-free telephone help line, 1-800-MEDICARE (1-800-633-4227), to get the information.
In the following, Dr. Bradley responds to some frequently asked questions regarding the CMS Nursing Home Quality Initiative and IPRO's role.
Q. How does IPRO operate and how does it go about improving health care in New York? A. CMS was very interested in finding and hiring experts to review medical practices and began to identify nonprofit health care review organizations as potential contractors in each state. We were created in 1983 in response to that call for assistance to improve health care and are now the CMS quality improvement organization for our state. Since then, we have evolved into proactive quality improvement specialists. We have a staff of physicians, nurses and health and communications professionals in various fields who work directly with health care providers and assist them in bringing about quality improvements. We also fulfill our mission by providing the general public with information regarding health care issues. For example, we recently completed statewide campaigns to educate consumers of the importance of getting flu shots and pneumonia shots. Q. Why is this initiative taking place? Is there a problem with quality at nursing homes? A. We believe most of the 17,000 nursing homes certified by Medicare and Medicaid nationwide provide good, quality services. However, the quality of care is often inconsistent and can vary from facility to facility. A major thrust of this effort is to establish a set of quality criteria that consumers can use to compare nursing homes, and can act as a baseline measure for future quality improvement. Prior to this, no single set of comparison measurement criteria for nursing homes existed. Q. How is this program different from others that have been attempted? A. For starters, this is a massive effort that involves compiling reports and statistics from 17,000 nursing homes across the United States. It's the first time that consumers have been given the opportunity to access this much information about nursing home quality without ever leaving their homes or offices. All a consumer needs to do to access the information is to visit Medicare's Web site at www.medicare.gov or call the toll-free number at 1-800-MEDICARE (1-800-633-4227). And it's the first time Medicare has funded quality improvement assistance to nursing homes at no cost to them. Q. Who are the likely users of this service? A. The estimated nursing home population in New York State is about 117,000 nursing home residents living in more than 680 nursing homes. That means there are lots of families out there who have an interest in nursing home quality. The service will benefit a broad spectrum of consumers, but we believe the primary users will be the growing population of emerging caregivers who are in the process of making a nursing home decision for their loved ones. As a large number of baby boomers are sandwiched between children still living at home and aging parents who can no longer care for themselves, this service becomes even more important.Also, families who already have a loved one in a nursing home are learning to use the information to evaluate existing care in comparison to state averages and other homes in the area. We also know that nursing home administrators themselves are very interested in how their facilities compare to others.
Q. What quality areas are listed on the Web site? A. CMS tracks numerous quality measures and has calculated 10 of these for public reporting and improvement. They are divided into two categories, long-term residents and short-term residents. Among the measures are: percent of residents who need more help doing daily activities; percent of residents with pain; and percent of residents with pressure ulcers, which are more commonly referred to as bed sores. The data show the percentage of residents in each facility experiencing certain conditions, such as pain or bed sores. In general, lower percentages indicate a greater quality of care. Consumers should keep in mind, however, that some nursing homes specialize in particular types of care for residents, meaning the population of those kinds of patients may be higher for that particular facility. Q. How is making this information public going to improve nursing home quality? A. In two ways. The first is that increased consumer awareness, knowledge and questions asked of providers are drivers of quality improvement as nursing homes strive to satisfy clients. As is the case with most services, consumers will gravitate toward providers who offer the best quality. This program gives consumers tools they can use to compare quality among nursing homes in their areas when making a nursing home decision. Consumers with a loved one already in a nursing home will be able to monitor their respective facility and be able to ask specific questions of administrators.But the second, very important part here is that many nursing homes have begun to buy into this process and are committed to improving the quality of their services. Our staff at IPRO is already working closely with nursing homes that wish to improve and are in communication with consumers who desire the highest quality of care.
Q. Are these measurements the only factors consumers should consider? A. Certainly not. The new quality measures are a good starting point, but are just one set of tools consumers now have at their disposal. They should personally visit nursing homes, interview administrators, speak to families who have loved ones in the facilities, look at proximity of the facility to their homes and consider many other factors. This program is not intended to answer all questions about nursing home quality. It's one more tool-albeit an important and useful one-for consumers in making a nursing home decision.With 20 years' experience in health care quality evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations. Based in Lake Success, New York, IPRO also holds contracts with private-sector clients to improve the quality of privately financed services.