President Obama has signed into law the Improving Medicare Post-Acute Care Transformation Act (the IMPACT Act). This Act provides $11 million in funding to establish an electronic collection system to help improve the “five-star rating program” that has been used to evaluate the quality of care of nursing homes for the last few years. The system previously required self-reporting of certain critical information (such as staffing levels and patient events) among the approximately 15,000 nursing homes in this country. That self-reporting system has resulted in the number of nursing homes receiving four and five stars (the highest level of quality of care per the system) increasing from 37 percent in 2009 to almost half in 2013.
So the question is whether the nursing home care in this country has improved that much in four years or whether the information being self-reported is skewed by the nursing homes themselves. The IMPACT Act hopes to establish a system that requires verification of the data that is being reported by the nursing homes. For example, no longer can nursing homes simply say they employ “x” number of nurses, certified nurse assistants, therapists, etc., now they are required to verify that with payroll information that must be provided electronically into the system.
The hope is that the new verified data will provide a better picture for people who have to go into nursing homes, their families and their physicians. It is hoped that the system will eventually allow those looking at such information to determine important factors such as:
Information is power, and the more information that is available to the consuming public to make rational decisions is always a good thing, especially where health care of loved ones is involved. Ideally, a system should provide other critical information, such as:
The law also allows Medicare to review hospice programs in which a large proportion of patients receive care for six months or more, which is considered a long hospice stay. The changes come as the number of hospices has grown rapidly in recent years, from 2,500 organizations caring for about 870,000 patients in 2005 to 3,600 caring for about 1.2 million in 2011. For-profit hospices now dominate the field, and many are affiliated with national chains.
Nursing home facilities should also be required to report the number of new admissions who signed arbitration clauses. The arbitration provision in nursing homes, while unconscionable, has been sanctioned by many of our courts. Potential new residents and their families should be able to determine how many new patients or family members (based upon the total population) are signing arbitration agreements. This type of information could assist greatly in determining how serious a facility is about providing quality of care to its patients.
Beginning in January, nursing homes’ ratings will also be based partly on the percentage of its residents being given antipsychotic drugs. Nursing homes must already report this statistic – 20.3 percent of long-term nursing home residents currently receive such medications – but until now it has not figured into a facility’s rating. Plans to add other measures are also underway, the officials said, including the percentage of residents who are readmitted to the hospital, and the percentage discharged to the community. Brian Lee, executive director of Families for Better Care, a nursing home watchdog group, said the next step the federal government should take is to improve the requirements for what nursing homes report about their ownership. Although basic information is available on the federal website where the ratings are available, the names of the chains that own or manage the homes are rarely listed because of the companies’ complex business structures. He observed: “It could be some company that is 10 states away. You have no idea.”
Lastly, the facilities should be required to report whether they have liability insurance to cover negligence of their staff and the amount of that insurance. While nobody wants to have to sue the facility, they need to know that if their loved one is seriously hurt, injured or killed because of the negligence of the healthcare provider that there is coverage available to pay a claim, if filed.
Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, which oversees the rating system, said she hoped that higher-quality reporting would lead to better health outcomes for patients. She said:
We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries.
Greg Crist, a spokesman for the American Health Care Association, the lobbying group that represents for-profit nursing homes, said many of the changes would capture data reflecting quality improvements that the industry had already been working on. He stated:
We’ve seen the improvements in quality across the board. Some questioned that a few weeks ago. Yet this push for greater accuracy should help reassure patients and families those improvements are both real and making a difference in improving lives.
Although the federal health care law, passed in 2010, required that nursing homes’ staffing data be collected electronically, the provision was never adopted. Instead, nursing homes reported their staffing levels on a form during their annual inspection, which was rarely audited. The homes will begin reporting the data electronically in 2015, but the information will not be reflected in the ratings until 2016, officials said Monday.
Advocates for residents of nursing homes said improving the reporting was crucial. Mr. Lee, of Families for Better Care, observed:
Nursing home quality hinges upon high staffing levels. If we are able to get better information on staffing levels, the higher the quality is going to be in the long run.
While the IMPACT Act is a move in the right direction, it falls short to fully arm new patients and their families with the information needed to ensure their loved ones are getting the best care available. Our firm applauds Congress and the President for taking measures to ensure that the information provided is more accurate and that nursing homes are held accountable for being truthful in their reporting.
Source: New York Times
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