New QIO Report Highlights Nursing Homes’ Progress

A new progress report on CMS’ Quality Improvement Organization Program, a five-year project designed to enhance the quality of services for Medicare beneficiaries, notes key achievements since the implementation of the program. These achievements include significant reductions in adverse drug events, infections, wounds and use of restraints in nursing homes.

In August 2014, CMS redesigned the QIO program for which 5,000 nursing homes were recruited to participate. The following are some of the achievements among participating nursing homes:

  • 44,640 potential adverse drug events prevented
  • 3,374 pressure ulcers were prevented or healed in 787 facilities
  • 6,250 Medicare beneficiaries in 981 facilities are now restraint free
  • 85,149 fewer days with urinary catheters for Medicare beneficiaries.

The QIO program “hopes to unite nursing homes, key stakeholders and organizations throughout their communities to share tools, knowledge and technology to achieve system-wide improvement.” According to a recent Inspector General report, one in five nursing home residents suffer preventable harm.

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CMS Strengthens Five Star Quality Reporting System For Nursing Homes

In a press release sent out earlier today, CMS strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give more families precise and meaningful information on quality when they consider facilities for themselves or a loved one. The announcement marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015.

The star ratings allow users to see important differences in quality among nursing homes to help them make better decisions. CMS rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS uses these categories to offer an overall star rating.

Beginning today, nursing home star ratings will:

  • Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.
  • Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.
  • Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.

To see a fact sheet on Nursing Home Compare 3.0, click here.

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CMS Expected To Change Five Star Rating System For LTC Facilities

According to industry sources, CMS is expected to unveil major changes to Nursing Home Compare today that could cause long-term facilities to lose rating stars. Sources believe CMS is changing the overall cut-off points related to achieving certain star levels. 15% of facilities could lose one or two stars virtually overnight if 11 new quality measures go into effect under the new system. So far, CMS has declined to comment. There is a Skilled Nursing Open Door Forum, where the matter is expected to be discussed, starting at 2 p.m. ET today.

In addition to the changes in the ratings system, CMS will add measures for short-stay and long-stay antipsychotic use to the ratings matrix. CMS Chief Medical Officer Patrick Conway, M.D., confirmed last year that the Five Star system would start including antipsychotics measures in 2015.

Click here to see the agenda with the call-in information.

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Nearly 20% Drop In Antipsychotic Use In LTC Facilities

The National Partnership to Improve Dementia Care in Nursing Homes, a public-private coalition under the guidance of CMS, has recently released findings showing a nearly 20% three-year decline in antipsychotic use.  Leaders at the American Health Care Association (AHCA) say they plan to keep the momentum going to further curb antipsychotic use in nursing homes. According to CMS data, 19.2% of nursing home residents were receiving an antipsychotic medication in the third quarter of 2014 – down from 23.9% in the fourth quarter of 2011. The AHCA’s goal is to further reduce off-label use by another 10% this year and 5% more by the end of 2016. The decline in antipsychotic use is evidence of the success of the Quality Initiative the AHCA embarked on three years ago. The coalition was originally “developed to improve dementia care through the use of individualized, comprehensive care approaches” and seeks to “promote a systematic process to evaluate each person and identify approaches that are most likely benefit that individual.”

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New Program Decreasing Antipsychotic Use In This Minnesota Nursing Home

Antipsychotic drugs, typically used to treat serious mental diseases, are prescribed to nearly 300,000 nursing home residents nationally. The FDA says the drugs can increase the risk of death for people with dementia. Although many nursing homes continue to use antipsychotic drugs to treat dementia, some nursing homes are finding alternative methods to treat residents. Doctors at a nursing home in Minnesota have been able to reduce the use of antipsychotics by 97 percent, far exceeding their initial goal of 20 percent. Doctors started seeing positive changes in residents as the use of antipsychotics dropped. Residents started interacting with each other and people who had not been speaking started speaking again.

How did they do this? A program called Awakenings. The program is designed to address what makes residents unhappy. The head of the Awakenings program says that everyone on the staff is trained to know and understand the residents’ likes, dislikes, and life stories. This way, any staff member can spot a problem behavior. Once the problem is identified, staff can works towards curbing it. Awakenings borrows elements from various techniques, including aromatherapy, white noise, pet therapy and validation. Experts say the key to the success of the program is relieving agitation that is common with people with dementia-something other nursing homes usually manage with antipsychotic drugs.

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LTC Liability Costs Anticipated To Increase 5% In 2015

According to a recent analysis, long term care providers should prepare for higher liability costs, which are expected to increase by 5% in 2015. In 2015, the projected loss rate is $2,030 per occupied bed, up from $1,940 this year. However, the report authors say that liability expenses may differ significantly from state to state. Kentucky, West Virginia and Florida are among the costliest states for providers due to their high liability costs, and Texas has one of the lowest liability costs of the states profiled in the report. The analysis is based on about 13,700 claims from 34 providers, representing 17% of long term care beds nationally.

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40 States Plan To Increase Nursing Home Medicaid Rates In 2015

According to a new report by the Kaiser Family Foundation’s Commission on Medicaid and the National Association of Medicaid Directors, states are increasing Medicaid reimbursements to nursing homes. In the current fiscal year, 39 states have increased nursing home Medicaid rates and 40 states plan to increase rates in fiscal year 2015. Rates are also rising for other major providers, including physicians and managed care organizations. However, states are also looking for ways to limit the number of people receiving care in institutional settings. In fiscal year 2013, 33 states took actions to fund for home-and community-based care and in fiscal year 2015, the number will rise to 47.

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