HHS Announces Pilot Nursing Home Evaluation Project
HHS Secretary Tommy Thompson yesterday announced that the Centers for Medicare and Medicaid Services will begin to publish information on the quality of care in nursing homes next year to "spur improvements" and help patients with long term care decisions, the Washington Post reports. Thompson said that the pilot project will begin in January in five states -- Colorado, Ohio, Maryland, Rhode Island and Washington. CMS will publish initial results from the pilot in April, and agency officials hope to publish information about nursing homes in every state by October 2002. According to CMS Administrator Thomas Scully, "the clear intention next October is to go national with the same kind of program." In the pilot project, CMS will publish nursing home information based on 11 "quality measures" (Walsh, Washington Post, 11/20). CMS will study seven measures of chronic care quality, including weight loss, infections and declines in activities, and four measures of post-acute care quality, including rehospitalization and improvement in walking. Thompson said that the information will allow patients to "compare the performance" of nursing homes and would "put pressure" on state officials and nursing home operators to improve care (Washington Post, 11/20). "If you're compared with your peers and you're not measuring up, you're going to do everything you can to improve it," he said (Auge, Denver Post, 11/20). CMS officials said that next year patients could access the information on the Internet at www.medicare.gov or through a toll-free telephone number. In addition, Scully said that the agency will use some government funds provided to Medicare Quality Improvement Organizations, which monitor Medicare providers nationwide, to purchase newspaper advertisements in April to publicize the information (Washington Post, 11/20). Thompson said that in the future he hopes to offer similar information on hospitals and health clinics (Carter, AP/Philadelphia Inquirer, 11/20).
The National Citizens' Coalition for Nursing Home Reform described the pilot project as "helpful" to patients but "no substitute for vigorous enforcement of health and safety standards," including annual inspections of nursing homes. Larry Minnix, head of the American Association of Homes and Services for the Aging, which represents not-for-profit nursing homes, called the program "a major first step" that should lead to "more consumer-friendly information" about nursing homes. However, the Washington Post reports that the project "appeared to fall short of suggestions made earlier this year" by Scully. In June, Scully said that CMS would assign "numerical scores" to Medicare providers, including hospitals and nursing homes, and "widely publicize" the findings through newspaper advertisements, the Internet and toll-free telephone numbers. Scully said yesterday that he "never intended to assign numerical scores" or rank nursing homes, but sought to establish a "broad set of standards" that patients could use to compare nursing homes (Washington Post, 11/20).
Meanwhile, Sen. Charles Grassley (R-Iowa) and Rep. Henry Waxman (D-Calif.) have raised questions about nursing home inspections (Fulton, CongressDaily, 11/19). In a letter sent to Scully on Friday, the lawmakers "complained" about a September proposal that would allow federal inspectors to cite nursing home violations as "widespread" only in cases where they could document that a problem affected 75% of the residents in a facility. Grassley and Waxman said that the plan would "confuse and potentially mislead residents and family members seeking to learn about nursing homes." In addition, they said that the proposal would "weaken" nursing home inspections, and that "thousands of nursing homes with serious violations could receive lesser citations." State and federal officials base their inspections on a sample of the population at a nursing home (AP/Philadelphia Inquirer, 11/20). The new proposal could "make it almost impossible" to determine widespread violations, they said. According to the letter, "The semantical change you seek brings an Orwellian result. By lumping all violations affecting between four residents and 74% of residents in the same category, the CMS proposal lessens the usefulness of these classifications and limits public information about nursing home conditions." The letter concluded, "Your change will mean the appearance of widespread violations will reduce appreciably, yet the inexcusable reality of widespread harm will remain the same." A CMS spokesperson described the proposal as "an informal communique" to industry and interest groups and "only an effort to get advice on how to simplify the inspectors' manual," adding, "It doesn't change any of the standards" (CongressDaily, 11/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.