Nursing Home, Home Health Quality Measures to Undergo Overhaul, With More Disclosure for Consumers

Payroll audits to ensure proper staffing and better tracking of the use of antipsychotic medications are just 2 new items that the Centers for Medicare and Medicaid (CMS) will add to its list of quality measures for nursing homes starting in January, the agency that oversees all Medicare spending announced Monday.

The changes are due to passage of the Improving Medicare Post-Acute Care Transformation Act (IMPACT) which President Obama signed Monday. Some of the changes will bring managed care concepts to the home health sector, where regulations have not been updated in 25 years. Included is a provision for expanded patient care coordination, which makes a licensed clinician responsible for referrals and assuring that the patients’ needs are met at all times.

Updates to the Nursing Home Five-Star Quality Rating System, and changes to the Home Health Conditions of Participation were unveiled by CMS Administrator Marilyn Tavenner and CMS Chief Medical Officer Patrick Conway, MD, who is also the deputy administrator for innovation and quality. Where applicable, proposed regulatory changes were also listed Monday in the Federal Register.

Added oversight of antipsychotics comes after reports and studies, from groups that include the American Psychiatric Association and the American Association of Retired Persons, that some nursing homes prescribe these medications for off-label uses such as dementia to make patients easier to manage, even though they are not otherwise indicated. CMS’ addition of this quality measure comes after the agency reported in 2013 that off-label use of antipsychotics in nursing homes had started to decline.

Changes to the nursing home rating system cover 5 broad areas, including:

• Focused inspections, done in cooperation with states, that will be based on sampling to allow officials to verify data reported to CMS used in quality measures. CMS has piloted this system, according to a statement from the agency.
• Payroll-based staffing reports, based on quarterly electronic reporting, to allow the data to be audited and to not only staffing levels, but also turnover, retention, and the types of personnel hired.
• Quality measures based on claims that will track how much nursing homes are relying on prescription antipsychotics, as well as rehospitalization and community discharge rates.
• State transparency requirements that will give consumers and family members better access to timely information on web sites, including inspection reports.
• Scoring methods will be revised to reflect a facility’s quality rating, with an ongoing emphasis on data that is not self-reported.

“Nursing homes are working to improve their quality, and we are improving how we measure that quality,” Dr Conway said in a statement. “We believe the improvements we are making to the Five Star system will add confidence that the reported improvements are genuine, are sustained, and are benefiting residents.”

Proposed changes to the Home Health Conditions of Participation include strengthening patient rights, better communication, a greater focus on patient wellbeing. According to CMS, 5 million Americans receiving Medicare and Medicaid benefits receive home health services from 12,500 Medicare-certified agencies. The overhaul to the home health regulations is the first since 1989, according to CMS.

Shortfalls in nursing home and home health care were most recently documented in a sweeping report from the Institute of Medicine (IOM), Dying in America, which found failures in end-of-life care at almost every level. Among the problems the IOM report noted are “perverse incentives” that promote more intensive care than patients and families may desire, and regulations that keep patients in nursing homes or hospitals when some would prefer managed care at home.

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