Making sense out of quality measures in long-term care

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Marty Stempniak, Staff Writer
Marty Stempniak, Staff Writer

Dan Ciolek has spent some 30 years in long-term care, and though he's become adept at quite a few topics in the field, one thing he's still trying to make sense of is quality measures.

I spoke recently with the American Health Care Association therapy guru for the May profile page in McKnight's Long-Term Care News. (An extended version of the story that appeared in print can be found here.) We spent a lot of time talking about the industry, in addition to some of his personal interests, such as his dog, Bingo, his love for red wines, and his diehard fandom for the Philadelphia Union.

There was so much more to say, though, it's worth sharing it here, rather than letting his words gather dust in my pile of older reporter's notebooks.

When asked what takes up most of his hours at AHCA, reimbursement, of course, was top-of-mind. Because, as he said while pointing to Maslow's hierarchy of needs, if you can't pay to keep the lights on and for your nurses to show up, it's hard to get to whatever's next on the list.

“The No. 1 priority for our organization that I'm working with right now is making sure that our payment systems make sense and that they're adequate enough to take care of our residents,” said the associate VP of therapy advocacy. “If they're not able to take care of folks, then everything else is irrelevant.”

But running parallel to that, and almost a No. 1A rather than No. 2 priority, is quality measurement. What are the quality measures that are most important, he asked — particularly from the perspective of the physical therapist? And if there are options between two interventions, Ciolek asked, how does long-term care work with the government to develop measures that help determine what care is most appropriate, along with educating frontline clinicians to understand and address resident needs?

“As clinicians, we may develop a narrow-minded standpoint of looking on with blinders and focusing on the ability of a person to move their legs or walk,” he said. “But the broader perspective is how does that affect their whole quality of life and their ability to function safely wherever they may live? What haven't we addressed?”

And besides just defining what quality is, to both the resident and the caregiver, Ciolek said, how should we as a long-term care field measure it? How do we report it? And once all those questions have been answered, how does the AHCA — which represents more than 13,500 skilled nursing centers and assisted living communities, among other facility types — make those members aware? “Because ultimately, that's what allows for the best, most successful possible care for the older adult population,” he said.

Maybe, when you're stuck on a long shift, it can be hard to take off those blinders and see care quality from the point of the resident. Readmissions might be the ghost you're chasing, but the senior you're caring for just assumes that he or she is not going to have to go back to the hospital. They may be much more concerned with being able to take a walk with that grandkid or go to the bathroom without any assistance.

“Victory could be returning somebody home. Victory could be stabilizing them enough that they can have the highest quality of life, even though they're not able to return home,” Ciolek said. “Those are the types of things that we need to be focused on, and how do we do that the best? That's part of my role that I work a lot on.”

“But again, Maslow's hierarchy, you've got to make sure that you stay financially viable and then as you do that, you make sure that you're able to raise the bar of quality for people who are doing this work well, and then bring quality up to a level that is better than it is today for the people who aren't there.”

The AHCA gave providers a peek earlier this year into some of the goals it has in mind to advance quality over the next three years, as McKnight's has reported. Those include reducing both hospitalizations and off-label use of antipsychotics by 10%, along with boosting functional outcomes by 15%, and resident satisfaction by 10%. Those four new focus areas are all part of the organization's Quality Initiative, which launched back in 2012 and has already helped make sizeable reductions in rehospitalizations and off-label antipsychotics use.

To monitor progress among its skilled nursing members, AHCA is lining up data against measures developed by both CMS and National Quality Forum.  They also mesh well with the quality-driven goals of accountable care organizations and managed care organizations.

“Continuing to focus on these key quality areas not only betters the lives of residents, but helps long-term care providers succeed in an evolving health care market,” National Center for Assisted Living Executive Director Scott Tittle said back in March.

What quality goals is your organization looking to pursue to continue evolving and making yourself a more attractive referral partner? Feel free to share your thoughts. And don't forget to check out our Profile article on Ciolek.

Follow Staff Writer Marty Stempniak @mstempniak.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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