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Rewarding leadership: The ACHCA Annual Award

February 1, 2008
by Eli Pick and John Sheridan
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For the second year, top-performing facilities in Quality Measure rankings will be acknowledged at the ACHCA national convocation


Achieving a universally recognized state of quality in a long-term care facility is certainly no simple feat. From the sheer challenge of implementing established standards of quality criteria, to management theory teaching that quality care and service yield both operational and commercial success, to consumer advocate groups who are frequently only too happy to point out our shortcomings—our business is rife with unique challenges when it comes to the issues of quality performance.

Given this, our organization's endless journey in advancing excellence in long-term care leads us to seek and acknowledge those individuals who have achieved a demonstrated measure of clinical achievement, good service, compliance excellence, reduced liability exposure, and commercial success. Rising to not only meet, but to exceed, all of these challenges is undeniably a remarkable accomplishment that is achieved only by those who possess stellar leadership capabilities.

We know that this type of leadership and commitment to quality exists among our colleagues. Therefore, in order to recognize, honor, and showcase this leadership, the American College of Health Care Administrators (ACHCA) introduced the Administrator Leadership Recognition at last year's annual convocation in Charlotte, North Carolina.

2008 again provides the opportunity for us to confer distinction upon Administrator leaders in each state who achieved top QI/QM rankings for pre-selected outcomes for their facilities.

The two measures selected last year as points for comparison and evaluation were: Use of Restraints and Short-Term Residents’ Pain. These measures were specifically selected because they have a minimum number of variables and are not impacted by risk adjustment or pre-selection bias in an organization's admission process. They were selected based on their utility as performance indicators rather than as population profiles.

Selection of measures also took into account the need to control for organizations that specialize in high-risk populations, as they may have disproportionate risk for complications as compared with organizations whose population may have moderate to low risk of complications, thus skewing their QI/QM performance. Although it is recognized that this variability cannot be completely controlled for, it can be minimized as a factor in maintaining the integrity of the Administrator Leadership Recognition.

This year, the QMs included will be Pain, Restraints, and Pressure Ulcer High-Risk, with facility occupancy and survey performance as screening criteria. In other words, the facilities achieving the highest rank in their states will be further matched as to occupancy and low level of citations on annual survey.

It should be noted that states that do not include top performers compared to facility scores in other states will not be included in the competition.

Background

The Centers for Medicare & Medicaid Services’ (CMS) Web site, http://www.medicare.gov/NHCompare, offers information such as the Quality Measures and Quality Indicators (QM/QIs) scores for various facilities and organizations in an effort to assist consumers and other interested parties in comparing performance of nursing homes using standardized measures. The QMs are generated based on the mandatory Minimum Data Set (MDS) assessments submitted regularly to each state regulatory agency.

The MDS, a federally mandated measurement tool, captures specific data at predetermined time intervals during each resident's nursing home stay through the use of extensively detailed resident assessments. The MDS measures are focused on capturing rates of functional, clinical, and emotional decline in individual residents. It should be noted that the absence of negative results with the submission of a facility's MDS is frequently equated with quality outcomes.

While CMS disclaims that the Nursing Home Compare Web site is a definitive source for selecting or identifying best-performing organizations, it does provide information that can be used in conjunction with other sources to assist in making placement decisions for loved ones. The site also provides objective criteria indicating whether a facility is performing positively with regard to quality issues or, instead, needs to improve.

We are pleased to be able to use the public information available from CMS (even though it is sometimes perceived as emphasizing the negative aspects of nursing homes rather than the positive) to applaud and celebrate the best of our profession. ACHCA has taken the opportunity to shift the emphasis from media coverage as usual to what is truly positive about the long-term care industry. Many nursing homes provide exceptional care and services on a daily basis to over 1.5 million residents. Recognizing at least some of these leaders by name calls attention to long-term care reality.

To identify those top-performing organizations whose Administrators are eligible for the ACHCA leadership recognition, eHealth Data Solutions, a long-term care data and information company based in Cleveland, Ohio, analyzed national, publicly available MDS data from CMS and proceeded to rank order it within each state. Based on this analysis, the top-performing nursing homes and their Administrators have been identified and will be notified this February that their Administrator is eligible to receive the leadership recognition on behalf of their organization.

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