The AHCA/NCAL Quality Initiative

Long term and post-acute care leadership from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) have announced a multi-year initiative to meet new quality goals, including reducing hospital readmission rates and improving staff retention.

The Quality Initiative focuses on four goals designed to improve quality of care in America's skilled nursing centers and assisted living communities.

1. Reduce Hospital Readmissions: By March 2015, reduce the number of hospital readmissions within 30 days during a SNF stay by 15 percent.
2. Increase Staff Stability: By March 2015, reduce turnover among nursing staff (RN, LVN, CNA) by 15 percent.
3. Reduce the Off-Label Use of Antipsychotics: By December 2012, reduce the off-label use of antipsychotics by 15 percent.
4. Increase Customer Satisfaction: By March 2015, increase the number of customers who would recommend the facility to others up to 90 percent.
(Please note: NCAL is currently developing its specific measures and targets.)

The Quality Initiative goals have been defined for the next three years to foster sustainable change and set specific benchmarks for the long term and post-acute care profession to build upon. AHCA/NCAL is challenging its membership to hold itself accountable in ensuring a higher quality, lower cost health care system.

"The quality initiatives goals set forth by the AHCA compliment our efforts in Indiana as we move towards the most robust value-based purchasing program in the country," said Scott Tittle, President of the Indiana Health Care Association. "The combined focus of these measures and those in the VBP program relating to reducing employee turnover, improving staff retention, and achieving high marks in employee, resident, and family satisfaction should result in improving the experiences of residents and staff in our member facilities.  Indiana members want to thank the AHCA for taking this very important step and being the leader nationally in improving resident care."

Reaching the targets set in each goal in the Quality Initiative will improve the health of thousands of seniors and people with disabilities, while at the same time driving down health care costs. When AHCA members achieve the goal of reducing hospital readmissions by 15 percent, 26,000 fewer people will go back to the hospital each year. Improving staff satisfaction will result in more consistent staffing in long term and post-acute care settings, keeping more than 615,000 in their jobs.  Less off-label use of antipsychotic medications will help patients avoid the health complications that come with the drugs. More satisfied residents and families means that AHCA member facilities are fulfilling the mission of providing quality care.

AHCA/NCAL has created a volunteer-led Quality Cabinet to coordinate and monitor the progress of the Quality Initiative. More information about the Initiative is available online at qualityinitiative.ahcancal.org.

GAO Issues Study on Implementation of the Quality Indicator Survey

by Lyn Bentley, AHCA Senior Director of Regulatory Services

This week the GAO issued a study:  Nursing Home Quality: CMS Should Improve Efforts to Monitor Implementation of the Quality Indicator Survey.  The study states that CMS has not done an adequate job of monitoring the implementation of the Quality Indicator Survey (QIS).   While CMS has taken some steps to monitor implementation progress of the QIS, the monitoring has not been systematic nor is it consistent with federal internal control standards.

Of particular interest is the GAO position that “In the case of the QIS-based routine survey process, information collected through performance goals and measures could help CMS routinely monitor the extent to which the objectives of the QIS are being achieved.  This information could also inform future efforts by CMS to modify and improve the QIS process as needed.”  CMS agreed with the need for certain performance measures – particularly with regard to examining the effect of the QIS on surveyor consistency.

GAO Recommendations to CMS
• Develop a means – such as performance goals and measures – to routinely monitor the extent to which CMS is making progress in meeting the objectives established for the QIS;

• Develop and implement a systematic methodology to track state survey agencies’ progress with implementation activities; and

• Develop and implement a systematic method for obtaining, compiling, and sharing information from state survey agencies about their implementation experiences.

CMS Responses to the GAO Recommendations
CMS concurred with these recommendations and intends to:

• Establish new or modify existing measures or processes to more effectively monitor CMS’s progress towards meeting QIS goals and objectives.  CMS is already reviewing available data related to the QIS (for example, data on survey workload, survey deficiencies, and the number of surveys performed) to more effectively monitor the QIS and guide improvement efforts.

• Formalize the data collection method used to track states’ progress with QIS implementation activities.  CMS will institute an automated process to obtain updated information on states’ progress with training surveyors which, when combined with existing data, could provide a more accurate assessment of implementation activities in any state.

• Enhance existing and add new methods of sharing information on the QIS with states.  CMS plans to expand existing information sharing opportunities (for example, quarterly calls and presentations at annual meetings) to be available to all states, not just those in the process of implementing the QIS.  CMS is also considering using a web-based capability to facilitate sharing information on QIS implementation.