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Federal agency's charts to report quality of nursing home care

Monday, November 11, 2002

By Gary Rotstein, Post-Gazette Staff Writer

Savvy consumers trying to choose among nursing homes will have one more way to gauge the quality of care starting this week.

The federal agency overseeing nursing homes will begin publishing charts and percentages showing how each facility fares on certain care indicators, including the occurrence and extent of pressure sores, patients complaining of pain, residents forced into physical restraints and others.

Not everyone agrees that nursing home residents and their families care much about such clinical information, but government officials say the National Home Quality Initiative will spur competitive upgrades in care regardless of how many people view the charts or how often.

There's a "tremendous stimulating effect that having the information out in the public domain has on the providers, getting them to come forward and start working on quality improvements," said Dr. Barbara Paul, director of the quality measurement and health assessment group of the Centers for Medicare & Medicaid Services.

Starting tomorrow, the federal agency will publish the charts covering key categories of patient care for nearly every nursing home in America on its web site www.medicare.gov. Full-page advertisements with more limited chart information will be published Wednesday in the Pittsburgh Post-Gazette and 70 other newspapers nationally to publicize the new resource.

Because the target population is not all computer-literate, information about specific nursing homes will also be available by phone or mail by calling 1-800-MEDICARE (1-800-633-4227).

"This is just one more piece of information for consumers," Paul said. "We find that consumers [in a six-state pilot project] did find this information to be useful, but they also need to visit the home, talk to the staff. ... It gives them something in their hand when they go to the nursing home and want to talk about the quality of care there."

Trade associations representing many of the nation's 17,000 nursing homes have endorsed the project, but with cautions. The provider groups say they favor putting more information in consumers' hands, but that the new data might confuse rather than enlighten some people and it's not useful enough by itself to judge a facility.

In Ohio, one of the six pilot states where nursing home comparisons were published starting in April, "the reports we got back regarding consumer reaction were decidedly ho-hum," said Peter Van Runkle, president of the Ohio Health Care Association.

"I don't think consumers are terribly concerned about clinical issues that they don't even necessarily understand," said Van Runkle, whose organization represents for-profit nursing homes.

"Their interest lies in where the nursing home is located, what do other people who have used the nursing home think, what does it look like and smell like when they go there, and how responsive are the staff."

Cindy Boyne, state long-term care ombudsman for the Pennsylvania Department of Aging, recommends using the new data to supplement both personal visits and state inspection surveys detailing any problems in the homes. Those reports are available on paper at each nursing home or under "nursing home information" on the state Department of Health web site, www.health.state.pa.us.

She said the ombudsmen in each county's department of aging will be familiarizing themselves with the new data and will help explain it to callers upon request. Government officials also hope social service staffs of hospitals obtain the information and use it when advising families whose members need to be discharged to nursing homes.

The Centers for Medicare & Medicaid Services has contracted with private companies across the country to educate the public about the quality measures. Known as quality improvement organizations, they also will help nursing homes improve their performance on the measures, which are updated every three months.

"A lot of consumers want a report card, something to say this home is No. 1, and that's not what [the new information] is intended to do," said Joanne Benteler, communications director for Quality Insights of Pennsylvania, the quality improvement contractor within the state.

But, she said, there will be value in comparing facilities to one another in their percentage of patients experiencing various types of problems, and in looking at whether an individual nursing home reduces the share of those problems every three months.

A "risk adjustment" formula is used to factor in the differences between nursing homes and the frailty level of the patients they serve, trying to enable a fair comparison in the extent of their problems.

Government officials say the existence of the public comparisons has spurred nursing homes in the pilot states to seek help from the quality improvement organizations and attempt changes they might not have made otherwise.

Quality Insights of Pennsylvania is supposed to provide technical assistance to at least 10 percent of the state's nursing homes, who can apply for it on a volunteer basis.

There is nothing voluntary, however, about the comparisons that will be published on how nursing homes fare in levels of the following: residents with unexpected loss of ability in basic tasks; residents with pressure sores; residents with pain; residents with physical restraints; residents with infections; short-stay residents with delirium; and short-stay residents' ability to walk better.

Some nursing homes are going to have percentages at the bottom of the list in those categories, and they may have to be prepared to defend themselves to residents' families. Still, it's an option preferred by many in the industry, who have long complained that state inspection reports are an unreliable indicator of nursing home quality.

"It's a good first step," said Ron Barth, president of PANPHA, representing nonprofit nursing homes in Pennsylvania.

"While the public reporting measures are not yet perfect, it does get us started on the road to being judged by standardized, research-based information," he said.

Gary Rotstein can be reached at grotstein@post-gazette.com or 412-263-1255.

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