State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. CMS Public Reporting Initiative and Quality Improvement Organization (QIO) Involvement

05/15/2003

Washington State was a pilot state for the recent federal piloting of national public reporting of quality measures (QMs). Respondents there had very mixed opinions of the QM public reporting, though general agreement among those who commented was that "quality indicator" rather than "quality measure" was a more accurate descriptor for the measures, since those interviewed did not believe that the QMs are the only aspect of quality that should be considered when making judgments about facility quality.

Some consumers in Washington were also skeptical of the QM initiative, saying that the QMs are too clinical and that they did not believe there was good correlation between performance on QMs and "real quality." Consumers also argued that the Federal Government should do more to assure that there is more consumer (resident) representation on federal quality initiatives such as the QM and QIO projects.

Officials in another state believed that information on CMS Nursing Home Compare website was too general and that the website needed to post more details to be really helpful to states. They thought it would be preferable to post all CHSRA QIs for each nursing home. Program staff in one state thought that CMS should post five years of survey and complaint data plus selected QIs. Respondents were also concerned about timeliness of data, since it heavily impacts the value of the posted information to consumers.

Regarding the new QIO initiative, many respondents from state survey agencies believe that the QIO program was an untapped resource that could be used, along with the state's survey agency, to work together and bring about changes in facility practices necessary to improve quality. One state believed CMS would be better served to award that responsibility (and associated funding) directly to the states. Some respondents suggested that the role of the QIO as an "improver" may be undermined by the QIO's required function as an "enforcer." Officials in another state were more concerned about the QIO's lack of experience with nursing facilities.

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