Nursing Home Oversight

1. Nursing Home Oversight • Survey Activity • 50% of the overall surveyor’s 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 CMS’s 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 SurveyProcess • 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 QI’s 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 - NationalRoll 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.