Quality improving in nursing homes: CMS review

Quality measurement efforts positive in nursing homes: CMS review
Quality measurement efforts positive in nursing homes: CMS review

A comprehensive review of CMS quality measurement efforts since 2006 paints a mostly positive picture of quality measurements in nursing homes. 

The “2015 National Impact Assessment of the Centers for Medicare & Medicaid Services Quality Measures Report” issued Monday, shows “clear progress in improving the healthcare delivery system to achieve the three aims of better care, smarter spending, and healthier people,” a CMS spokesperson noted in published reports. 

The report, to be produced every three years, is mandated by the Affordable Care Act. "The key findings of the [report] indicate that CMS is making a difference for the patients we serve," acting CMS Principal Deputy Administrator Patrick Conway wrote in his blog post on Monday. 

Conway said a key finding in the report concluded that 95% of 119 publicly reported performance rates across seven quality reporting programs showed improvement during the study period (2006-2012). 

Other positive findings included less evident race and ethnicity disparities and positive impacts the quality measures are having on patients beyond the Medicare population, including Medicaid. 

Nursing home quality measurement programs included in the analysis included: The Nursing Home Quality Initiative; Home Health Quality Reporting Program; End-Stage Renal Disease Quality Incentive Program; Hospice Quality Reporting Program; Inpatient Rehabilitation Facilities Quality Reporting Program; and the Long-Term Care Hospitals Quality Reporting Program. 

In preparing the impact report, researchers looked for undesirable effects of quality measures in hospitals, ambulatory centers and nursing homes. Among those effects were worsening quality in unmeasured areas of care (otherwise known as “teaching-to-the-test”), reporting inaccurately high performance (“gaming of the data”) and avoiding high-risk or challenging patients (“cherry-picking”). 

After a comprehensive review of the medical literature across the study period, researchers said they found “little empirical evidence to support or refute the possibility that undesired effects have occurred [in nursing homes] as a result of the use of quality measures by CMS.” The nursing home portion of the report proposed a number of actions to consider, including:  

  • Development of proactive validation of electronic clinical quality measure/electronic health record data by establishing front-end edits and clinical algorithms appropriate to a given measure. 
  • Establishing a third-party data validation process specific to each program/setting performed by a CMS contractor or authorized vendor to ensure accurate reporting and to provide insight regarding potential unintended consequences of quality measurement.
  • Development of balancing measures in new measure development projects. 
  • Guidance concerning the use of measure exclusions in collaboration with the National Quality Forum.
  • Periodic national provider surveys to develop estimates of the type and prevalence of unintended consequences associated with measure use.
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