Pay-for-performance project draws mixed reviews

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The Centers for Medicare & Medicaid Services plans to launch a pay-for-performance demonstration project this year among 200 to 250 nursing homes. While nursing home advocates praised parts of the project, they also expressed some reservations about quality measures in the initiative.

The three-year, $3 million pilot program would award additional payments to facilities that demonstrate better quality, the agency said earlier this month. The agency plans to assign quality points in four areas: staffing, hospitalization, Minimum Data Set and inspection results. CMS does not plan to penalize lower-scoring facilities.

Associations have suggested that the agency should look again at some these categories, such as staffing. The project would award points to homes with higher nurse-resident ratios, as well as lower turnover. But the American Health Care Association said the nation's nursing shortage should be factored into payment determinations. Facilities may incur added staffing costs during the project without knowing if they will receive an increase in payments if their performance improves.

Also, MDS performance is not necessarily a good way to compare facilities, according to the American Association of Homes and Services for the Aging. The test program would compare facilities based on measures such as the percentage of residents with bed sores, the percentage who are tied to their beds to keep them from wandering and the percentage who need help with activities of daily living.

Some homes that don't perform well on MDS scores may actually provide better care not reflected by the measures because they have a sicker population, said Barbara Manard of AAHSA.