Quality Measures get a mixed reception. (News Notes).

Despite a short delay in deference to the midterm elections, the Centers for Medicare and Medicaid Services (CMS) has expanded its Quality Measures (QMs) data to the national level, following a six-state pilot project of its Quality Initiative. Oddly enough, mixed reviews have come from the federal government itself, while LTC professional associations have agreed to soldier on, with help from agencies called quality-improvement organizations (QIOs).

While Health and Human Services Secretary Tommy G. Thompson praised this "new approach to bringing about better quality care in our nation's nursing homes" and suggested that the project "will grow and improve over time, with improving data and new levels of collaboration to help nursing homes ensure high-quality care," Congress' investigative arm, the General Accounting Office (GAO), sang a different tune. In its bluntly titled report Nursing Homes: Public Reporting of Quality Indicators Has Merit, but National Implementation Is Premature, the GAO quickly cuts to the chase: "CMS has not yet adequately resolved a number of open issues regarding the appropriateness of the quality indicators selected for public reporting and the accuracy of the underlying data." The GAO also criticizes CMS for not providing the QM data in the six pilot states in an accurate, consumer-friendly manner. (To read the report, visit www.gao.gov/cgi-bin/getrpt?GAO-03-187.)

Meanwhile, another recent area of discussion has been the role of QIOs-state-based CMS contractors that have primarily provided information and consultation to hospitals and are now moving into skilled nursing and other healthcare sectors reimbursed by Medicare. During a teleconference late last year involving four healthcare organizations, David Schulke, executive vice-president of the American Health Quality Association (AHQA), acknowledged that budget restraints will prevent QIOs from providing direct assistance to all facilities that request it. Rather, he said, conferences, mailings, and information posted on the Web will allow them to provide all facilities with some information. He suggests that a large number of facility representatives could meet with a QIO every few months to discuss best practices. Schulke admitted this option is not as intensive as going on-site to every nursing home, but is a powerful, resource-efficient option, nonetheless.

Schulke also acknowledged that some QIOs are entering long-term care for the first time. They have been hiring personnel from the provider sector to help them meet this new need, he said.

But the road to improved quality doesn't end with QIOs, said Suzanne Weiss, senior vice-president for advocacy at the American Association of Homes and Services for the Aging (AAHSA): "QIOs are a catalyst, but we don't expect them to be the sole source of improvement in CQI [continuous quality improvement]. We hope they will spawn more CQI."

In addition to AHQA and AAHSA, the American Health Care Association and the National Association of State Long-Term Care Ombudsman Programs participated in the teleconference.

The QM data are accessible via CMS' Nursing Home Compare service at www.medicare.gov and Medicare's help line ([800] 633-4227). The six chronic-care measures are percentage of residents with loss of ability in basic daily activities, infections, pain, pressure sores, pressure sores (with additional facility-level risk adjustment), and physical restraints. The four post-acute care measures are percentage of short-stay residents with delirium, delirium (with an additional facility-level risk adjustment), who walk as well or better on 14-day assessment as on 5-day assessment, and pain.