National standardized surveys for nursing homes in the works
James M. Berklan
You kind of get the sense that a government watchdog didn't want to believe the good numbers coming out of its latest research into nursing home care, so it felt the need to introduce uncertainty.
In the end, it did what most researchers do: Call for more research, and in this case also further refinement of processes.
But the most important thing mentioned in the 48-page report is something that emerged only as a recommendation on page 27. It was not mentioned in the report's first-page highlights, nor anywhere else: creation of a standardized survey methodology “across all states.”
If you're raising one eyebrow, incredulously asking, “Wait a minute, there's not a standardized methodology already?!” rest assured you're not alone. It would also mean you're somewhat new to this game. Providers and numerous other stakeholders have pointed out inconsistencies in surveys for years.
That's why we have to take the following observation with a patient, federal grain of salt: “HHS stated that it would set timeframes and milestones for the development and implementation of a standardized survey methodology."
It's not exactly reason to uncork the champagne and open the party crackers, but it's a start.
It's also an overshadowed development in a report that packed enough other punches. Titled “Nursing Home Quality: CMS Should Continue to Improve Data and Oversight,” this General Accountability Office production is recommended reading if you plan on staying in the business.
At a very minimum, you can peruse state-by-state trends for average number of serious deficiencies per nursing home; number of consumer complaints per nursing home; total nurse staffing hours per resident day; total registered nurse staffing hours per resident day; and percentage changes in eight selected quality measures.
The overall good news for providers is, the numbers improved in four of these five areas. The not-so-good news: That fifth category (consumer complaints), and the fact that researchers hedged on all of their findings, be they "good" or "bad."
Consumer complaints is the sore-thumb category: They've risen 21% over the decade ending 2014 (the most recent period for which statistics are available).
At the same time, the number of serious deficiencies cited per facility dropped 41%. However, shame on the Centers for Medicare & Medicaid Services, report authors implied, because the agency does not have sufficient systems in place to check whether this is truly the case.
The numbers for overall nurse staffing hours per resident day also improved. They rose in all but one state, for an overall climb of 9% from 2009 to 2014. That includes a 51% rise in registered nurse time (0.5 hours per day to 0.8).
As for quality measures, nursing homes' scores showed improvement in all eight areas spot-checked from 2011 to 2014.
It seems, however, that when it comes to providers' self-reported information for staffing and quality measures, regulators believe in the “Trust but verify” theme — minus the trust part.
So they're not prepared to say with any certainty that nursing home quality has improved in recent years. The numbers might tend to point that way, they admit, but they want better oversight and analysis of data.
That's where things like payroll-based journaling of staffing levels is going to come in mighty handy, they figure. No more "just take our word for it" numbers come July 1.
It all also leads up to the day in fiscal 2019 when nursing homes will join hospitals as eligible to be docked by Medicare funders for poor outcomes. The data noose is slowly but surely tightening for lesser performers.
To get a better idea of how you compare to peers in your state, and other states, go ahead and peruse the full report. Among its intriguing mentions is that one (unidentified) state has reduced the survey frequency for many nursing homes down to just once every 36 months due to “resource constraints.”
For every such provider "break" mentioned, however, the report seems to offer an equal or greater counterweight.
A deeper look at the report may give you a better vision of your future, for better or worse.
James M. Berklan is the Editor at McKnight's Long-Term Care News. Follow him @JimBerklan.