As the Centers for Medicare & Medicaid Services (CMS) continues to push all healthcare sectors toward pay-for-performance reimbursement models, few sectors have more to gain—or lose—than long-term care. Finding new ways to improve the quality of services, reduce infections and hospital readmissions, bolster documentation and streamline reporting will all become necessary for business in the days ahead.
Ruta Kadonoff, vice president of quality and regulatory affairs for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), has spent the past year at the helm of her organization’s national quality initiatives and recently helped to host its fifth annual Quality Initiative Symposium.
Kadonoff spoke with Long-term Living Senior Editor Pamela Tabar on quality’s increasing impact on reimbursement, the current and upcoming regulations and what long-term care (LTC) facilities can do to stay ahead of the quality curve.
With the emphasis on pay-for-quality payment models, does LTC need better ways to define and measure quality?
Definitely. We haven’t had great measurements in place to look at the outcomes in short-stay post-acute care. We haven’t done a great job of measuring what skilled nursing provides in terms of improvement in functional status, quality of life, mobility. We have a therapy outcomes workgroup working on that right now, and we hope to have some measures ready this year to put before the National Quality Forum for endorsement. The whole realm of quality measurement is expanding into these areas, and CMS and MedPAC have both expressed interest in what we’re doing. We also have a committee working on measuring the customer experience. The nursing home arena has never had a survey instrument rolled out nationally where we can measure consistently and reliably across facilities what the customer experience is.
How can we make a quality standard that can reach across the scope of long-term/post-acute care, from rehab to hospice?
We’re working with Dr. Nicholas Castle at the University of Pittsburgh, and he has distilled questions, some of which are generic and broad across the different levels of long-term and post-acute care and some of which are specific to particular types of care. That’s where we’ll start creating the set that we’ll ultimately recommend. There are aspects that will always apply, things like dignity and meeting your own goals for care—whether the goal is to rehab and go home, or to be pain free and comfortable.
What new tools has AHCA developed to help LTC facilities assess their quality risks?
At the  Quality Initiative Symposium, we announced that through a partnership with PointRight, we now have a risk-adjusted 30-day rehospitalization measure called OnPoint-30 that is generated from MDS data. It’s much more timely than anything we’ve had available in terms of a national data set, since previous data have always been generated from claims. This allows members to see their rehospitalization rates within four to six months of submitting MDS, as opposed to two years with claims data. We launched it on our free member LTC Trend Tracker.
Should LTC facilities be more proactive about quality initiatives and get ahead of the CMS pay-for-quality curve?
Absolutely. AHCA stands firmly behind incentivizing and rewarding providers who provide good quality care and have good outcomes. The overall trend is heading that way on the state and federal levels. We want our members to recognize the importance of quality, not only from the perspective of doing what’s best for their residents, but also for their business success. It makes sense for facilities to think about how to demonstrate that they provide value.
How did your prior experience as deputy director of The Green House Project help prepare you for today’s patient-centric care initiatives?
I spent a great deal of time with providers who were implementing the Green House model, and through their successes and challenges, I saw what a truly person-centered environment can offer. It shaped my whole world view of what is possible in long-term care. Particularly on the work we’re doing now with the reduction of antipsychotic use through person-centered dementia care, all my thinking about that relates back to my experiences with Green House and the Alzheimer’s Association. It’s seeing what kinds of outcomes and quality of life are possible when truly person-centered care is provided that assures me that we can do a good job with that goal and can improve people’s lives.