CMS Releases QIO List of Nursing Homes

VHCA (2/8/2008)

On February 5th the Centers for Medicare and Medicaid Services (CMS) publicly released a list on their website identifying approximately four thousand nursing facilities targeted for improvement based upon two measures - prevalence of pressure ulcers and use of physical restraints.   The list, entitled "National List: Nursing Homes Targeted for High-risk Pressure Ulcer and/or Physical Restraint Improvement," is available here.  Please note that this is a very large download and contains all facilities across the country included in the CMS list.  A smaller file containing the Virginia pages extracted from the CMS file is also available.

Facilities on the list targeted for improvement with high risk pressure ulcer rates were identified based on publicly reported quality measures of high risk long stay residents with pressure ulcers in nursing facilities with at least two of the most recent three quarters of data showing results of 14 or more percentage points away from the goal of six percent.  Facilities targeted for improvement in physical restraints were identified based on quality measures of residents who were physically restrained daily in facilities with at least two of the most recent three quarters of data showing results of eight or more percentage points away from the goal of three percent.

The list was released as part of CMS’ announcement of the 9th Scope of Work (SOW) for the Quality Improvement Organizations (QIOs), in effect August 2008 – July 2011.  This new SOW specifically tasks the QIOs with a focus on reducing the prevalence of pressure ulcers and reducing restraint usage in nursing facilities nationwide.   Specifically CMS stated that, “As part of the 9th SOW, QIOs will be required to offer assistance to specific nursing homes and hospitals that have not recently performed well on important quality measures.”  The Virginia Health Quality Center is the QIO in Virginia. 

AHCA has expressed concern with the way in which CMS has characterized the facilities named on this list.   AHCA notes that, “CMS repeatedly acknowledges the positive gains made in the quality of care and services provided in our nation’s nursing facilities, yet the agency chose to label these 4,000+ facilities as ‘poor performers.’   The release of such a list paints a negative broad-brush stroke against the entire profession, which is working closely with CMS to improve care quality.   As well, the public naming of these facilities does not take into account the acuity of patients or the case mix of the facility.” 

AHCA is also disturbed by the public release of the list because the criteria used to determine which facilities are included are inherently flawed.   AHCA has been on the record for many years noting that many of the quality measures are inaccurate and unable to assess quality care.   For pressure ulcers, the measure tracks prevalence with no bearing or consideration as to where the ulcers were acquired or their stage.  Ironically, concern was highlighted by CMS in a recent communication to Congress where they unequivocally stated that while there has been a significant decrease in the “prevalence of pressure ulcers in nursing homes,” they are concerned because, “prevalence of pressure ulcers is negatively affected if hospitals discharge patients to nursing homes in less stable conditions.”

Kerry Weems, acting administrator of the U.S. Centers for Medicare & Medicaid Services, stressed that the nursing facilities named in each state may not be the lowest-performing, as they may be doing well in areas other than the ones under scrutiny in the current QIO program.  By posting information about these facilities, CMS strengthens its commitment to increasing the transparency of information available to consumers in the healthcare market by providing the public with the information needed to make informed choices about health care,” said the CMS release. Additional information about the 9th SOW and the list of facilities is available on the CMS website.