A Message to AHA Members:

In November 2001, the Centers for Medicare & Medicaid Services (CMS) announced the creation of the Nursing Home Quality Initiative (NHQI), a program designed to provide consumers with detailed information and quality measures on the nation’s Medicare and Medicaid-certified nursing homes.  Earlier this month, the AHA issued a Regulatory Advisory on the program, providing background information on the initiative and alerting facilities to the nine-day data preview period, which ended on October 22.  The advisory can be found on the AHA’s Web site at www.hospitalconnect.comkey_issues/patient_safety/whatsnew/whatsnew.html.

On November 12, CMS will hold a press conference to publicly launch the NHQI campaign and accompanying Web site that lists the nursing home quality measures data for all nursing homes and hospital-based skilled nursing facilities.  The NHQI Web site can be accessed at www.medicare.gov.  The next day, on November 13, CMS will run newspaper ads in each state, providing a sample of quality data for that state’s 50 largest nursing homes or skilled nursing facilities.  The NHQI campaign and its activities may garner national media attention as well as stimulate interest from your local media.  

This gives you and your facility an opportunity to share with the public the quality programs in place at your facility.  Focus on your commitment to quality improvement and be prepared to address any specific concerns that may be highlighted by your facility’s report.  In order to assist you with these efforts, we’ve developed the attached talking points and information, which are also available at the AHA’s web site:

·        Preparing for the NHQI
·        NHQI Talking Points
·        Explaining NHQI Post-Acute Quality Measures

America’s hospitals are dedicated to providing safe, quality patient care.  The AHA will continue to work with other hospital and nursing home groups, as well as CMS, to improve the accuracy and validity of the NHQI quality measures. 

If you have questions regarding media relations, feel free to call the AHA’s Alicia Mitchell at (202) 626-2339 or Amy Lee at (202) 626-2284. For more information on hospital-based nursing home policy, call the AHA’s Rochelle Archuleta at (202) 626-2320.

                                       Preparing for the Nursing Home Quality Initiative                                              

  • Understand and review your facility’s quality measures report.  If you need guidance in accessing and/or interpreting your quality report, contact your state’s Quality Improvement Organization (QIO) for technical assistance.  A complete list of QIOs can be found at the American Health Quality Association’s Web site, www.ahqa.org/pub/connections/162_694_2450.cfm.  Also, compare your National Health Quality Initiatives (NHQI) results to the state and national averages, available on the Centers for Medicare & Medicare Services’ (CMS) Web site beginning November 6.
  • Share this advisory and your quality report with your board, public relations staff, referring physicians, quality assurance team and other key staff.  Make sure they understand the CMS data and your facility’s quality program, including current and pending quality activities.
  • Identify a spokesperson to respond to media inquiries about the NHQI.
  • Check with your state's QIO to learn about planned local media outreach regarding the NHQI and determine how your facility's media efforts correspond to the statewide media campaign.  Consider a proactive approach and invite the media and public to visit your facility.
  • Be prepared to provide an overview of your facility’s quality program and discuss what makes a hospital-based facility different from a stand-alone facility.  (Hospital-based skilled nursing facilities tend to treat patients, following hospitalization, who are medically complex and often experience shorter, more intensive stays.)  The attached information about the post-acute care quality measures may assist with this strategy.
  • Evaluate your facility’s quality program and determine if additional opportunities for quality improvement exist within your organization.  Consider collaborating with others, such as the QIO and local health partners.
  • Consider conducting workshops with local health partners such as social workers or discharge planners to develop key partnerships, review your NHQI quality measures, and discuss your quality program.
  • Evaluate the CMS coding procedures being used by your  staff to assure optimal accuracy when submitting the quality data used by CMS for the NHQI and other reporting purposes.                 

Nursing Home Quality Initiative
Talking Points

  • At [name of facility or hospital], we are dedicated to the care and comfort of our patients and their families.  We especially want to help families and caretakers learn more about the care being provided by our facility.
    • Give examples of how you ensure quality care at your facility.  You may want to focus on several continuous quality improvement projects.
  • We strongly believe that the public should have access to data that are meaningful, valid and comparable.  Our ultimate goal is to inform consumers so they can be more involved in their health care decision-making.
  • This data release is an important step in the right direction, but should be viewed as a work in progress.
  • It’s especially important to note that hospital-based skilled nursing facilities treat patients following hospitalization who often have medically complex needs.  For many patients, a stay in a hospital-based skilled nursing facility is more intensive and shorter in duration than for patients in a chronic-care nursing home.
  • While we are pleased that the government’s report recognizes some of the differences between hospital-based and chronic care nursing homes, all of these differences were not fully taken into account in this report.  Also, other data limitations prevent consumers from knowing the true quality of care provided without visiting the facility.
  • Many patients in a hospital-based nursing home experience improvement in their health status during an intense, but short stay.  For example, a patient may resume walking within three days, yet this improvement would not be captured for Nursing Home Quality Initiative (NHQI) reporting because the “Improved in Walking” quality measure is designed to measure improvement only on the 14th day.
  • It’s important that consumers using this information recognize that hospital-based skilled nursing facilities often care for sicker patients.  Data from this report should be one of several resources consumers use as they make health care decisions.
  • We encourage everyone to be an active participant in their care.  Feel free to ask questions about the care you or your loved one will receive.

Nursing Home Quality Initiative
Explanation of Post Acute Quality Measures

In addition to six chronic core quality measures, these four post-acute quality measures are being reported by the CMS Nursing Home Quality Initiative (NHQI). 

Short Stay Residents with Pain

This measures the percentage of short-stay residents that have either daily pain that reaches a moderate level at any time during the assessment period OR excruciating pain at any frequency during the assessment period.

Things to consider:

  • Measuring pain is a matter of assessment and often a facility with good pain management protocols will record a higher prevalence of pain than a facility that is less attuned to identifying and documenting pain.
  • Describing pain and its intensity is subjective and can be influenced by a caregiver as well as a resident's cultural background, religion, or personal opinions and decisions.
  • The measure captures only pain as reported during each resident's assessment period – this may or may not be representative of the typical condition experienced by a resident during the full stay.
  • Certain post-acute residents may have conditions that are accompanied by a certain level of pain that may not be completely avoidable (e.g., post-surgical pain, orthopedic problems, etc.).
  • Therapy provided to recover maximum function, a primary purpose for a post-acute resident's stay in many cases, often results in some level of pain or discomfort that may not be avoidable.

Short-Stay Residents with Delirium[With a Facility Adjusted Profile] and
Short-Stay Residents with Delirium [Without a Facility Adjusted Profile]

This measures the percentage of short-stay residents with delirium.  Delirium develops quickly and involves changes in awareness, attention, cognition and perception, and represents a sudden and significant decline from the previous level of functioning.  This measure is reported two ways – both with and without a facility-adjusted profile.  This adjustment factor is applied to take into account whether a large proportion of the facility’s residents have symptoms of delirium at the time of their admission into the facility, which is an important distinction for some hospital-based facilities. 

Things to consider:

  • Many residents entering a nursing facility after a hospital stay may have one or more symptoms of delirium.
  • Consumers may not distinguish between, and require an explanation of, the differences between “delirium,” “dementia” and “senility,” and therefore may overestimate the prevalence of delirium in a facility.  As such, the significance of this quality measure may be perceived to be greater than warranted by the actual size of the population with delirium.

Short-Stay Residents Who Improved in Walking

This measures the percentage of short-stay residents whose level of independence in walking has been maintained or improved between the five-day and 14-day assessment periods.  Higher values on this measure indicate a higher percentage of residents that improved in walking.

Things to consider:

  • Unlike all of the other measures, a higher score on this measure is considered good.
  • The measure assesses change between the five-day and 14-day assessments only, limiting its ability to capture improvement over the entire course of a resident's stay if it exceeds 14 days.  It also fails to reflect many post-acute patients who improve rapidly in activities of daily living, including walking, and are discharged prior to the completion of a 14-day assessment since rehabilitation-oriented stays of less than 14 days will not be reflected in a facility's scores on this measure.

NOTE:  The American Association of Homes and Services for the Aging generously provided assistance in developing these descriptions and comments.


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