Nursing homes' ratings unveiled

Federal report cards include `risk adjusting'

$11 million pilot project

April 25, 2002|By Diana K. Sugg and M. William Salganik | Diana K. Sugg and M. William Salganik,SUN STAFF

WASHINGTON - Calling it "important and wonderful news for the elderly of our country," U.S. Health and Human Services Secretary Tommy G. Thompson unveiled report cards yesterday on the quality of care in hundreds of nursing homes in Maryland and five other states.

The ratings should give families a better idea of how nursing homes compare in areas such as controlling their patients' pain, preventing weight loss and bed sores, and avoiding the use of physical restraints.

But experts say the evaluations are far from a breakthrough; rather, they are simply a more sophisticated way of measuring care. Everyone agrees, though, that the ratings should be just part of the decision for the 2.5 million nursing home admissions every year.

With an aging population and staffing shortages in nursing homes nationwide, experts say that measuring quality in nursing homes is crucial. But how to do that is a complicated, controversial question. For months, regulators, statisticians, advocates and members of Congress have been wrangling over the federal ratings, unveiled yesterday as a pilot project.

While industry and advocacy groups generally praised the effort, some skeptics said it won't help consumers, who often have to choose a nursing home quickly, in a crisis. Sometimes, because of insurance, bed availability or a medical condition, there is no choice.

"It's the equivalent of putting National Guardsmen in airports. It makes you feel good, but it doesn't really do anything to help you," said Dr. Robert Kane, professor of long-term care and aging at the University of Minnesota School of Public Health.

While recognizing more work needs to be done, Thomas A. Scully, administrator of the federal Medicare program, defended the measures.

"They're not perfect," Scully said, "but we think they're very good, and better than anything that's been out there before."

Flanked by reproductions of full-page newspaper ads with nursing home scores that HHS is running today in the six states (including in today's Baltimore Sun), Scully and Thompson were joined at the news conference by a variety of trade, consumer and labor groups.

William L. Minnix, president of the American Association of Homes and Services for the Aging, which represents nonprofit homes, called it "a watershed - not a gimmick."

For the past few years, Medicare has published some raw quality data on its Web site. Several states, including Maryland, have or are developing their own nursing home reports. Some have helped facilities and regulators spot problems, and similar report cards - on cardiac care in hospitals, for instance - have driven drastic improvements.

But there is a huge hurdle in trying to measure the quality of nursing-home care: accounting for factors that might not be the fault of the facility.

A nursing home with an Alzheimer's unit, for instance, would appear to have more problems with dementia, when those numbers might be high simply because they have so many of those patients.

To make fairer comparisons, experts do something called "risk adjusting," and the new federal project is the most extensive attempt at that. Researchers used a few different techniques, including not counting certain patients. Hospice patients, for example, won't be counted in the weight-loss score, since the terminally ill are expected to show substantial weight loss.

"I don't think there are any absolute right answers or any absolute wrong answers. It depends on what kind of error you want to make," said Dr. Vincent Mor, an expert in the field and chairman of community health at Brown University.

Nursing home officials, who wanted the risk adjustment, had mixed opinions on how it worked.

An example of how facilities' scores were adjusted is provided by the Johns Hopkins Geriatric Center, which got a better rating for residents' bed sores on the federal evaluation than it did on Maryland's nursing home report card last year. Administrator Lisa Filbert said the federal data probably accounted for her facility's program to treat bed sores, which draws more of those patients.

But at Franklin Woods Center, administrator Bob Harris said he didn't see any evidence that their scores had been adjusted for the many difficult patients they accept.

Ronald Rothstein, who oversees two homes, Levindale and the Jewish Convalescent Center, said some data, like the pain management measure, show drastic swings from one quarter to the next.

Others said the process was rushed. Just recently, officials postponed the use of one new risk-adjustment method because they said it needed more testing.

"Ninety percent of what they're trying to do is good and laudable and we support. But the 5 percent we don't support is rolling this thing out in such a sloppy, reckless way," said Isabella Firth, president of Mid-Atlantic LifeSpan, a Maryland nursing home association.

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