The Good, the Bad and the Ugly
By Richard L. Peck, Editor
One thing you can say about Clint Eastwood movies-they always had the best titles. So much for that acknowledgment-let’s move on to the real topic of this: the federal government’s Nursing Home Public Reporting Quality Initiative. It began publicizing in April quality measures for all the nursing homes in six states and is scheduled to go national this October. It fits Mr. Eastwood’s movie title to a “T.”

First, “the good”: In theory, the program represents a start toward that quality improvement collaboration with regulators that provider organizations have sought for years. Part of it involves state-based Quality Improvement Organizations (or QIOs, of which more later) offering nonpunitive help and information to nursing homes wanting to improve their “scores.” Meanwhile, from the consumer standpoint, who can argue with providing families enough information to at least ask intelligent questions about facilities (although adminis-trators had better start beefing up their phone-answering staffs soon, if they haven’t already).

Then, “the bad”: As anyone in this post-Enron/Arthur Andersen era can tell you, numbers can be tricky. What is one to make, for example, of a nursing home registering in the high double-digits for pressure sores if, in fact, it specializes in treating pressure sores? One such facility in Ohio, noting that its 21% score was misleading in this respect, also complained about its “residents with pain” score of 36%: “If it was that high, we would have had the state all over us,” said the administrator in a news story, “but we’ve had four perfect surveys!” In short, if some nursing homes really are falling short in their quality measures, it would help if they understood why. The QIOs, which should help, will unfortunately be stretched so thin that they’re not expected to be directly available to more than 10% of the homes in their states.

And then, finally, “the ugly”: If your nursing home management is still struggling to comprehend MDS-based assessment, with all of its A8bs, B5fs, M2as, G1h(A)s, etc., etc., you had better get crackin’. Yes, you do have to be a rocket scientist-or an AANAC member-to understand these and how they were used in developing quality measures (regression analysis, anyone?). But they are at the heart of OBRA surveys, Medicare reimbursement and, now, your public image for quality. You have no choice but to take them seriously-at least until that day when government decides to simplify its regs and when purple elephants fly. NH

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