What's in a number? CMS quality-initiative data go live. (CMS Report Card).

NURSING HOME QUALITY REPORTS released April 24 by the Centers for Medicare and Medicaid Services (CMS) have drawn mixed reviews from providers and consumer advocates alike, although both camps agree that the program is an important step toward providing consumers with outcome-based information.

"We're very pleased with any initiative that will move us away from the current survey system," says Carl S. Young, president of the New York Association of Homes and Services for the Aging. "But calling this data 'quality measures' is not really accurate. Quality indicators and information available from the MDS data are a starting point for evaluating quality through careful investigation."

Donna R. Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform (NCCNHR), also supports the CMS initiative but cautions that the quality measures are still under development. "No one should choose a nursing home without visiting it and observing firsthand the quality of care," she says.

The reports, posted at <www.medicare.gov>, provide data on more than 2,500 nursing homes in six pilot states: Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington. Online "report cards" are based on nine quality measures ranging from excessive weight loss to the percentage of residents needing more help with daily activities. CMS has risk-adjusted the data. For example, residents admitted with pressure sores are not included in a facility's statistics for 90 days.

Public scrutiny

Perhaps most controversial are full-page newspaper ads in which CMS has published lists of local facilities and their statistics for pressure sores, assistance with daily activities, and long-term-stay residents with pain.

According to HHS Secretary Tommy G. Thompson, "You can well imagine that if you see your name up there and you're not measuring up to the nursing home down the street, you're going to work hard to improve your business."

Some nursing home operators say that it's the quality initiative itself that needs work.

One facility shown to be deficiency-free on Medicare's Nursing Home Compare was listed in a local newspaper as having the highest number of residents with pressure sores--26 percent. According to the facility's administrator, the high percentage was due to inaccurate coding of skin problems due to vascular disease.

"I don't have one bed sore in this entire facility," she says. "The tool that [CMS is] using is not giving an accurate picture."

Even though the quality initiative is a work in progress, it has raised consumer awareness and residents' family members are asking nursing home providers to explain how the numbers translate into quality of care.

"If this prompts people to call up their nursing home and say, 'What are you doing to make sure my mom does not get pressure sores?' then it's a very good thing," says NCCNHR's Lenhoff.

CMS expects to expand the quality initiative to all 50 states by the end of the year.