Findings should help nursing homes target ways to boost quality
Now that a report card grading nearly every nursing home in Rhode Island has been made publicly available, facilities are turning their attention to the next step in the process: improving care.
"I think homes will begin to really look at their protocols and ask themselves if there are things they could be doing better," said Dr. David Gifford, principal clinical coordinator for Rhode Island Quality Partners, a not-for-profit agency hired by the federal government to oversee health-care quality for Medicare recipients.
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"I think they realize there are things they can do beyond simply adhering to current regulations," Gifford said.
On April 24, quality ratings on 97 of Rhode Island’s 103 nursing homes – based on data collected in the fourth quarter of last year – were posted on the state Department of Health’s Web site, www.healthri.org. The listing was done in conjunction with a quality improvement pilot project designed by the Centers for Medicare & Medicaid Services (CMS), of which Rhode Island was one of just six states to participate.
The data from the pilot project includes nine measures of nursing home quality meant to allow consumers to make "apples-to-apples" comparisons of nursing homes.
Six of the nine measures are for "chronic-care" patients, or residents who are likely to remain in nursing homes long term. These include pain management, weight loss, infections, bedsores, use of physical restraints and decline in activities of daily living, such as dressing, eating and bathing.
The remaining three measures are for short-term, post-acute residents, who stay in nursing homes during the first few weeks after a hospital stay. For these residents, nursing homes were rated on pain management, managing delirium and improvements in walking.
Health officials said the objective of the public reporting is to improve the quality of care in nursing homes while providing objective information to consumers.
"This report brings us a step closer to complete measurement and reporting on quality in nursing homes, hospitals and other facilities," said Dr. Patricia Nolan, state director of health. "Just publishing these measures can help improve care,"
But health officials said the ratings should not be used as a measure to judge how well or poorly a facility is run. Gifford noted that several core services provided by nursing homes – such as feeding and cleaning patients and coordinating activities – weren’t directly measured in the survey.
Rhode Island Quality Partners offers voluntary help to Rhode Island nursing homes by offering technical information on care processes and, on a limited basis, the agency will perform on-site visits. Quality initiatives stemming from the pilot project initially will focus on pain management and preventing bed sores, Gifford said.
Nearly all homes already have active quality improvement programs in place, Gifford said. But the findings should help facilities spotlight specific areas for improvement.
Still, it will be difficult for facilities to make changes that require substantial funding, Gifford said. Between 70 and 80 percent of a typical nursing home’s revenue comes from Medicaid or Medicare, which won’t boost payments to help pay for specific quality initiatives or additional staff.
"With any business, if somebody comes along and says ‘you need to do this better, but you’re not going to get more money to make the changes,’ that’s tough," Gifford said. "The challenge isn’t necessarily ‘what does the literature say we’re supposed to do,’ because we already know that. The challenge is trying to figure out how to get it done on a day-to-day basis."
The federal pilot project will help the state meet the requirements of the Health Care Quality Reporting Act, which was passed in 1998 and requires the state to develop and report publicly on quality measures for all licensed health-care facilities. To comply with that law, state health officials last year released consumer-satisfaction ratings for all of the state’s community hospitals.
