Wisconsin Senator Russ Feingold introduced a bill today targeted at “improving the quality of care in nursing homes”. The bill was introduced by Feingold in response to the efforts of the Wisconsin Association of Homes and Services for the Aging (WAHSA – non-profit, industry trade association) to have the federal government investigate the wide discrepancies in enforcement actions occurring between various CMS regions as well as state to state (see a related post on the Apex E-News site at: http://wp.me/pD9Ac-3k ). The purpose of the bill is to direct the Secretary of Health and Human Services to have the IOM (Institute of Medicine) conduct a study on the survey and certification process. Per the text of the bill, little has been done since the original IOM study that produced new survey and certification requirements under OBRA 87 in the form of a review of the accuracy, methodology or effectiveness of the process. The full text of the bill is available here: http://www.wahsa.org/s3407.pdf
The IOM study is to focus or analyze the following;
- Current survey methods for evaluating nursing homes
- The nature and relationship between nursing homes/the industry and CMS and how such a relationship impacts efforts to improve quality
- The methodology used by CMS to survey and evaluate nursing homes
- The relationship between CMS and the state agencies that perform the survey and certification tasks
- An evaluation of how the states and their respective agencies implement the survey and certification process and the resulting variations and differences
- The objectivity and accuracy of the current process and criteria to assess nursing homes
- Effectiveness of current enforcement measures in creating systemic organizational change leading to measurable and sustained improvements in quality of care
- Whether the current system effectively measures and understands nursing homes that are undergoing or have completed cultural change efforts
- Whether the current system allows stakeholders or other agencies and entities to engage in other/alternative innovations to improve quality
- Alternatives to the current system
A report from IOM containing the results of the study plus recommendations for policy and procedural changes that improve the survey and certification process is due to the Secretary and Congress within 18 months of the passage of the Act.
The bill is now before the Senate Health, Education, Labor and Pensions Committee. Prospects for passage are unknown at this point. Regardless of whether the bill can pass, it is high-time that such an effort is undertaken by the Congress. OBRA 87 is antiquated in terms of its provisions and the current health care system, especially in-light of the clientele that nursing homes presently care for. The survey and certification process is capricious, ineffective at promoting quality, and impossible to understand point-in-time. It also has done precious little to promote quality instead, creating tension, bureaucracy and compliant behavior – none of which is good for the industry, the patients/residents, facility staff or facility leadership.