Targeting nursing homes under the Quality Improvement Organization program's 9th statement of work

Area of Science:

• Healthcare Quality Improvement
• Geriatric Care
• Public Health Policy

Background:

• The Centers for Medicare and Medicaid Services (CMS) revised its Quality Improvement Organization (QIO) program strategy.
• The new strategy focuses on nursing homes with poor performance in pressure ulcer and restraint use metrics.
• This shift responds to criticisms regarding the ineffective targeting of QIO resources.

Purpose of the Study:

• To analyze the implications of using narrow criteria for identifying nursing homes needing improvement.
• To evaluate the effectiveness of the CMS's targeted approach in the QIO program.
• To highlight the multidimensional nature of nursing home quality and its temporal variability.

Main Methods:

• Analysis of administrative data to identify targeted nursing facilities.
• Examination of performance on specific quality measures (pressure ulcers, restraint use).
• Assessment of facility performance across multiple quality dimensions and over time.

Main Results:

• Nationally, one in four nursing facilities is targeted for improvement.
• Significant state-level variation exists, with some states having nearly half their facilities targeted.
• Targeted facilities may excel in other quality areas, and performance can fluctuate over time.

Conclusions:

• The CMS's current method for identifying underperforming nursing homes is a blunt instrument.
• Relying on limited quality measures may misidentify facilities needing improvement.
• Supplemental strategies, including state input and integrated quality assurance, are recommended.