Measuring and Improving Skilled Nursing Facility Effectiveness

The Q2 2016 PX Advisoris focused squarely on Non-Acute Care. This post excerpts an article featuring Al Litwiller, a national expert on long term care in the U.S.

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Perhaps the easiest way for anyone to get a snapshot of the quality of skilled nursing facilities is to access the Five-Star quality ratings on the Nursing Home Compare website maintained by the Centers for Medicare & Medicaid Services (CMS) ( search.html). CMS analyzes health inspections, staffing reports, and quality measures to award a number of stars to each facility.

The star rating system is a quick reference for discharge planners to use as hospitals seek to reduce avoidable readmissions. There are other factors to use in evaluating nursing homes, but the 5-Star system is the best place to start. The CMS rating takes into account health inspections, staffing, and quality measures, and provides an overall rating. The example below shows the Star Rating profile of a facility that has been deemed a 1-Star. The star ratings are adjusted quarterly based on inspection reports. For example, the 1-Star facility below was at one time a 5-Star, but in subsequent inspections substantial deficiencies were identified, dropping their rating from 5 stars to 1 star.

The LTC Trend Tracker

The American Health Care Association provides its members with a LTC Trend Tracker (https://www.ahcancal. org/research_data/trendtracker/Pages/default.aspx), a Web-based tool designed to encourage quality improvement efforts in long-term care settings. The Trend Tracker enables skilled nursing facilities to benchmark their performance against their peer facilities. This tool not only provides benchmarking among skilled nursing facilities, but it can also be an invaluable resource for hospital discharge planning teams as they evaluate the best possible option for patient transfer.

Three Final Thoughts on the Hospital-Nursing Home Relationship

  1. Select the correct post-discharge destination the first time.

    As patient care moves out of traditional silos into a full continuum of care, it is imperative that hospitals know all community-based options available when discharging a patient. In today’s value-based payment environment, placing patients in the highest quality, least expensive setting the first time a patient is discharged is vital. Knowing the available options and the quality measures associated with each is crucial.

  2. Use common language across the continuum.

    As the continuum of care expands to meet more of the needs of each patient discharged from the acute setting, all clinicians anywhere along the continuum must learn to speak the same language and monitor the patient against a unified set of protocols as set forth in an individualized care plan.

  3. Use and follow comprehensive, continuum-based care plans.
    Also, as the continuum of care expands from the acute setting to all forms of non-acute services, a common care plan individualized to each patient will become essential.

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April 1, 2021