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Nursing Home Industry Broadens Quality Goals Ahead of CMS Rule

By Rebecca Adams, CQ Roll Call

May 6, 2015 -- The nursing home industry plans to announce that it will expand a 2012 initiative to improve quality, in a move that could feed into an upcoming federal regulation that the Centers for Medicare and Medicaid Services (CMS) is developing.  

New goals include further reducing the number of patients who are readmitted to a hospital after a stay, decreasing staff turnover, reducing the off-label use of antipsychotics in long-term residents, and increasing the number of facilities that report data from patient satisfaction surveys.

The industry has drawn scrutiny in recent years from Congress, the Medicare Payment Advisory Commission and the Centers for Medicare and Medicaid Services (CMS). The American Health Care Association and National Center for Assisted Living—which represents skilled nursing facilities and assisted living facilities—will announce details of the program at a press conference.

The proactive move could help position operators as they await the release of a new CMS quality improvement rule mandated by the Affordable Care Act. The law requires the Health and Human Services Department to expand quality improvement efforts through an effort known as Quality Assurance and Performance Improvement standards, or QAPI.

In September 2011, CMS launched a demonstration program in a small number of nursing homes that helped the agency develop best practices for helping facilities upgrade existing quality programs. The new industry standards build on that work.

"What gets measured gets improved," said Mark Parkinson, president and chief executive officer of the American Health Care Association and National Center for Assisted Living. "While the results are evident on paper, more importantly, they are felt each and every day in the lives of millions who enter our doors. This new initiative will help us reach even higher levels of quality, affirming to Congress and policymakers alike we can help with workable solutions for programs such as Medicare and Medicaid." 

The association has updated CMS on its framework, which the group's board of directors approved last week. The association is wagering that the industry goals are consistent with the principles of the new rule, though operators don't know what it will say or when it will be released.

The industry will set eight major targets.


  • Decreasing nursing staff turnover by 15 percent or achieving turnover of less than 40 percent by March 2018.
  • Reducing the number of unintended health care outcomes by March 2018.
  • Ensuring that at least 25 percent of member companies measure and report patient and family satisfaction survey results.
  • Reducing the number of hospital readmissions within 30 days during a skilled nursing center stay post discharge by an additional 15 percent, or achieving a rate of 10 percent readmissions by March 2018.
  • Increasing discharges of short-stay patients back to the community by 10 percent or achieving a high rate of at least 70 percent by March 2018.
  • Ensuring that at least 25 percent of member companies adopt measures for mobility and self-care of short-stay residents and report functional outcome measures.
  • Reducing the off-label use of antipsychotics in long-term nursing home residents by an additional 10 percent by December 2015 and 15 percent by December 2016.
  • Reducing hospitalizations among long-stay residents by 15 percent or achieve and maintain a low rate of 10 percent or less by March 2018.

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