Editor's Desk: A cash incentive test program for nursing homes in four states could shape your future

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James M. Berklan, Editor
James M. Berklan, Editor
If long-term care hasn't exactly been the lead story on the evening newscast lately, you can excuse the producers of the national broadcasts.

As of this writing, little things such as pirates taking Americans hostage off the coast of Africa, wars in Afghanistan and Iraq and, oh yes, the loss of life savings amid the credit and housing markets crises were dominating the airwaves.

But if someone had looked closely, my, what drama they also could have found in long-term care land. Major budget bills, pro union-organizing proposals, Five-Star ratings, MDS 3.0 intrigue. And that's not even kicking Obama healthcare reform proposals.

Worthy news items all. But not the one I'm looking forward to following the most over the next few years.
Tucked away in the final corner of March, not totally unnoticed by provider groups but still not ballyhooed to the right degree was another very intriguing news item.

Starting this summer, nursing facilities in four states will begin walking the plank, er, testing a pay-for-performance scheme from the federal government. Remember all the fuss about posting nursing home performance criteria–first via the Nursing Home Quality Initiative years ago and more recently with Five-Star? It's all been intended to lead in this direction, if not the precise program being tested. The goal is to bring us to a world containing only excellent and non-existent nursing homes, as one of my favorite long-term care leaders calls for regularly.

Therefore, my interest will lie in Arizona, Mississippi, New York and Wisconsin over the coming years. They'll be showing regulators, and the rest of us, how cash incentives for better, more efficient care work. Facilities joining the Nursing Home Value-Based Purchasing demonstration will be awarded points for performance on quality measures in four areas:  nurse staffing, avoidable hospitalizations, resident outcomes, and the scope and severity of deficiency citations the home has received during inspections. Nursing homes with the highest scores or the greatest improvement in their score will be eligible for a performance payment. The demonstration is expected to run from July 2009 through June 2012.

Then, the number crunching will take place and you can expect three things: changes to the Medicare payment system, more states and facilities swept into the pay-for-performance vortex. And broad coverage of it by newshounds everywhere.