CMS moves into action

Edition: September 2012 - Vol 20 Number 09
Article#: 4068
Author: Repertoire

For the more than 3 million individuals who rely on nursing home care in the United States in any given year, the Centers for Medicare and Medicaid Services (CMS) strives to provide effective, quality healthcare. That’s no small task considering 1.4 million people reside in the country’s 15,800 nursing homes, according to CMS. In its 2012 Nursing Home Action Plan, CMS sets forth a strategy to accomplish three interconnected objectives:

• Improve the individual experience of care.

• Improve the health of populations.

• Reduce the per capita cost of care for populations.

The action plan is comprised of five approaches, each of which addresses one or more of the three objectives:

Enhance consumer engagement (addresses objective #1). Consumers are essential participants in ensuring the quality of care in any healthcare system. The availability of relevant, timely information can significantly assist consumers in actively managing their own care, as well as enable individuals to hold the healthcare system accountable for the quality of services and support that should be provided. To that end, CMS seeks to provide information that can be readily accessed by the public. So, for instance, its website, www.Medicare.gov, features Nursing Home Compare, as well as other educational resources and information for consumers, families, and friends. CMS believes that involving people in healthcare policy decisions, as well as providing resident-centered care on an individual basis, will enhance the overall individual experience of care.

Strengthen survey processes, standards and enforcement (objectives #1, 2, 3): CMS is looking to improve the effectiveness of annual nursing home surveys, as well as the investigations that are prompted by complaints from consumers or family members about nursing homes. CMS also has improved the way data is captured from oversight of state surveys. By strengthening oversight and enforcement standards, CMS believes that state agencies will facilitate improvement at the population level in nursing homes. This, in turn, is likely to reduce the number of adverse events and preventable healthcare acquired conditions, leading to lower per capita costs. In addition, CMS is developing a feedback process to improve national consistency and information flow from providers to consumers. A process to communicate consistent, helpful feedback to individual complainants will improve the individual experience of care.

Promote quality improvement (objectives #1, 2, 3): CMS continues to promote comprehensive quality improvement programs in a number of areas, including reductions in the use of physical restraints and the prevalence of preventable pressure ulcers. In an effort to achieve these goals, the agency participates in the Advancing Excellence in America’s Nursing Homes program and supports the “culture change” movement. As such, CMS encourages facilities to examine their organization’s values, structures and practices, and transform traditional institutional approaches to those that are person-centered. The adoption of culture change and person-centered care principles can improve the resident’s and the family’s experience of care.

Participation in Advancing Excellence and other programs that set targets for performance improvement are likely to lead to improved health of the nursing home population. In many cases, improved quality may lead to reduced costs in areas such as potentially preventable hospitalizations of nursing home residents, prevention of pressure ulcers, and the prevention of rehabilitation costs associated with hip fractures due to falls.

Create strategic approaches through partnerships (objectives #2,3): CMS looks to combine, coordinate and mobilize many people and techniques through a partnership approach. The Department of Health and Human Services launched its Partnership for Patients program, with $1 billion in funding to achieve two aims by December 2013: a 40 percent reduction in preventable hospital acquired conditions, and a 20 percent reduction in 30-day readmissions. Up to $500 million of that funding is through the CMS Innovation Center (to improve patient safety). $500 million is earmarked to reduce readmissions through the ACA Section 3026 Community-Based Care Transitions Program. In addition, Quality Improvement Organizations (QIOs), State Survey Agencies (SAs), and other partners are committed to a common endeavor. And at press time, CMS was scheduled to launch a National Nursing Home Collaborative that focuses on preventable healthcare acquired conditions (HACs).

Advance quality through innovation and demonstration (objective #3): CMS seeks new ways to pay for and deliver care that will improve care and health while lowering costs. These projects include Medicare’s Nursing Home Value-Based Purchasing (NHVBP) Demonstration, which aims to promote high-quality care and prevent costly, potentially avoidable hospitalizations and develop plans to implement value-based-purchasing programs for payments under the Medicare program for both skilled nursing facilities and home health agencies. Additionally, through the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, CMS will partner with organizations to implement evidence-based interventions that reduce avoidable hospitalizations.

For more information, visit http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/2012-Nursing-Home-Action-Plan.pdf