Legislation calls for survey reform: More carrot, less stick. (Newsfronts).

LEGISLATION INTRODUCED IN March by Rep. Dave Camp (R-Mich.) is geared toward a more collaborative approach between nursing home operators and regulatory officials. The Medicare and Medicaid Nursing Facility Quality Improvement Act of 2002 (H.R. 4030) would allow nursing home inspectors to advise providers on ways to improve services and quality of care. It would also establish a range of incentives designed to reward providers for excellence, while providing technical assistance for struggling facilities.

Other provisions of the bill include shortening the waiting period for resumption of onsite staff-training associated with some government inspection penalties; allowing states to adopt innovative regulatory processes by establishing an eight-state waiver demonstration program; preventing government inspectors from overturning physicians' orders; and resolution of survey disputes through an independent review process.

According to Will Bruno, director of congressional affairs for the American Association of Homes and Services for the Aging, the proposed legislation promises to balance the "strong sticks" of the current regulatory system with "carrots" for improving quality of care.

"Among the pure incentives--the carrots--is a provision designed to facilitate the dissemination of information on best innovative practices," says Bruno. "Then there are Medicare/Medicaid provisions that would provide financial incentives for recognition of the highest-quality providers."

Charles H. Roadman II, MD, president and CEO of the American Health Care Association, comments that "It's simply common sense that the government should permit inspectors to talk with providers about the best way to provide quality care. This change is long overdue."