Administrative Memos

200402

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 08, 2004
SUBJECT: Enhanced NHQI Quality Measures
IPRO CONTACTS:

Pauline Kinney, R.N., M.A., L.N.H.A., Director - NHQI, ext. 402 or Patricia Gagliano, M.D., Medical Officer, ext. 547

In November 2002, the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, began a national Nursing Home Quality Initiative (NHQI). The goals of the initiative are essentially twofold:

1. To provide consumers with an additional source of information about the quality of nursing home care by providing a set of MDS-based quality measures on Medicare's Nursing Home Compare web site, and
2. To help providers improve the quality of care for their residents by providing them with complementary clinical resources, quality improvement materials, and assistance from the Quality Improvement Organizations in every state.

Many facilities have already made significant improvements in the care being provided to residents by taking advantage of these materials and the support of Quality Improvement Organization staff.

From the beginning of this Initiative, we have said that quality measures are dynamic and will continue to be refined as part of CMS's ongoing commitment to quality. Later this month, CMS will begin reporting an enhanced set of quality measures that have been endorsed by the National Quality Forum, a voluntary standard setting, consensus-building organization representing providers, consumers, and researchers.

The enhanced chronic care measures that will be posted on Nursing Home Compare are:

• Percent of residents whose need for help with daily activities has increased
• Percent of residents who have moderate to severe pain
• Percent of residents who were physically restrained
• Percent of residents who spent most of their time in bed or in a chair
• Percent of residents whose ability to move about in and around their room got worse
• Percent of residents with a urinary tract infection
• Percent of residents who have become more depressed or anxious
• Percent of high risk residents who have pressure sores
• Percent of low risk residents who have pressure sores
• Percent of low risk residents who lose control of their bowels or bladder
• Percent of residents who have/had a catheter inserted and left in their bladder

The enhanced post-acute care measures that will be posted are:

• Percent of short stay residents who had moderate to severe pain
• Percent of short stay residents with delirium
• Percent of short stay residents with pressure sores

Of the eleven chronic care measures listed above, four of the measures are clinically related. These four measures have been grouped into two pairs. If one of the measures in a pair is selected, the other measure will also be displayed on the Nursing Home Compare web site. The first set of paired measures is percent of low risk residents who have pressure sores and percent of high-risk residents who have pressure sores. The second set of paired measures is percent of low risk residents who lose control of their bowels or bladder and percent of residents who have/had a catheter inserted and left in their bladder.

CMS will provide you with a preview of your scores on the new measures through your QIES MDS system. Your MDS Coordinator should access these reports for you, as QIES is the same system your MDS Coordinator uses to transmit MDS data. The scores will be available for preview from January 12 through January 21, 2004. In addition, the look of the web site will be modified when the enhanced measures are posted so users will find it easier to understand.

Download the comparison of the initial quality measures and the enhanced set of quality measures. We encourage you to go to www.Medicare.gov/nhcompare/home.asp to view your current quality measure scores. Please note that the quality measure scores for all facilities are refreshed every quarter. We hope that you visit the site regularly and track your quality measures over time.

IPRO will continue to support the nursing home community in New York by distributing updated information concerning the enhanced set of quality measures as it becomes available later this month. In addition, IPRO will offer workshops on the enhanced set of quality measures shortly thereafter.

Over the past year, IPRO has been providing assistance with quality improvement in the nursing home setting with particular emphasis on pain, pressure ulcers and restraints. We are in the process of organizing support to help you improve your performance on the enhanced set of measures. Please be on the look out for upcoming notices.

Should you have any questions regarding this memorandum, please feel free to contact Pauline Kinney at (516) 326-7767 ext. 402 or Dr. Patricia Gagliano at (516) 326-7767 ext. 547.