Analysis of U.S. Nursing Home Care Quality Details Continuing Progress for Patients

Report at Spotlights Research that Could Lead to Meaningful Medicare Post-Acute Payment Reforms

May 06, 2013, 10:31 ET from Alliance for Quality Nursing Home Care

WASHINGTON, May 6, 2013 /PRNewswire/ -- A new wide-ranging report detailing long-term, post-acute and rehabilitative care quality trends in U.S. skilled nursing facilities (SNFs) shows continued improvement in key long and short stay quality indicators. The report also provides in-depth information on research that could lead to a system for uniformly assessing patients across all post-acute care (PAC) settings – and ultimately new needs-based Medicare payments for beneficiaries requiring post-hospital care.

Entitled "Insights & Progress: A 2013 Quality Report on Skilled Nursing Facility Care," the Alliance for Quality Nursing Home Care (AQNHC) report includes analysis prepared by PointRight, the premier national long-term care analytics firm. PointRight analyzed quality by utilizing Centers for Medicare and Medicaid Services (CMS) quality measures along with staffing and rehospitalization metrics.

Analysis of Specific Quality Indicators

Based on one set of standard metrics from CMS (MDS 2.0), SNFs improved in all four short-stay PAC measures: pain, pressure ulcers, influenza immunization and pneumonia vaccinations. SNFs also improved in eight chronic care (CC) measures: pain, high-risk pressure ulcers, catheters, restraints, activities of daily living (ADL) decline, weight loss, depression and pneumonia vaccination between 2003 and mid-2010. Only three long stay measures did not show improvement during this same period: urinary tract infections, incontinence and influenza immunization. (See chart attachment and also available at

Under the new, updated set of quality measures employed by CMS since 2011 (MDS 3.0), PointRight finds improvement in 13 of 15 measures – eight of which show statistically significant improvement over the six quarters studied (Q1 2011 – Q2 2012). Performance as measured by the long stay, incontinence and influenza immunization measures worsened; incontinence was statistically significant -- as it was in the previously reported period.

Steven Littlehale, Chief Clinical Officer of PointRight, stated, "The outcome data clearly indicates quality improvement for SNFs' long and short stay residents. CMS quality measures are almost exclusively measuring outcomes, and there is a paucity of process measures that describe how care is rendered. Regardless, the improvement of so many key indicators of quality for a sustained period of time is significant."

Rehospitalization, Survey Performance and Staffing Trends

Littlehale also said PointRight finds that the 30-day rehospitalization rate for post-acute skilled nursing patients showed a statistically significant decline from 21.6% in FY 2007 to 20.9% in FY 2011; that the average number of deficiencies and the percent of facilities with substandard quality of care (SQC) show improvement beginning in 2009; and that average nurse aide and licensed nurse hours increased from 2003 to 2011 while the percent of contract staff decreased during this same time period. "Incorporating other metrics into this evaluation of SNFs -- such as survey outcomes and staffing -- offers a better look into quality," continued Littlehale. "In this case while there are areas in need of improvement, many key indicators point in the same positive direction."

Alan G. Rosenbloom, President of the Alliance, said, "Consumers, lawmakers and facilities themselves need to know where quality is improving, where performance has reached a plateau, and where quality challenges persist -- thereby requiring vigilance on the part of the SNF provider community. It is clear that while there have been real and continuing successes, improvement must continue to be a significant focus for our sector and the many stakeholders with whom we are successfully collaborating."

Broader Implications to Post Acute Care Payment Reform

Rosenbloom also pointed to a key chapter of the report, "Developing Standardized Assessment Items for Post-Acute Care," which has significant implications for post-acute payment reforms. In the chapter, author Barbara Gage, Ph.D, Fellow and Managing Director at The Engleberg Center for Health Care Reform at the Brookings Institution, notes, "[s]tandardizing assessment items across the healthcare spectrum is an important step in improving communication, patient-centered coordinated care, quality of care, and developing a common language to describe patient complexity regardless of the setting in which the patient is treated."

"In Congress, and amongst the health care community, we are encouraged by heightened interest in modernizing Medicare's inefficient PAC payment system," Rosenbloom continued. " Step one is to ensure lawmakers better understand post-acute care has transformed to a system of multiple patient transfers involving varied levels of care. With this evolution, it is essential for the metrics that track rehabilitation quality to actually follow patients across transitions over a certain time period, as opposed to just individual stays at one specific post-acute setting."

CONTACT: Ellen Almond, 703/548-0019

SOURCE Alliance for Quality Nursing Home Care