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U.S. Begins Issuing Consumer Data on Nursing Homes
WASHINGTON, April 24 — The Bush administration released data today on the quality of care at more than 2,500 nursing homes in six states, and promised to publish similar information on those in all other states this fall, part of an ambitious project to help consumers evaluate the performance of health care providers. AARP, two trade associations for the nursing home industry and the Service Employees International Union, which represents 125,000 people who work in nursing homes, endorsed the project. They said the new data would help people select nursing homes and would motivate homes to correct deficiencies that have persisted for decades. Tommy G. Thompson, the secretary of health and human services, who has enthusiastically encouraged the initiative, said, "This is a huge step forward, probably the biggest step to improve the quality of nursing homes that this department has ever been involved in." Asked if the government intended to release similar data on the care provided by doctors and hospitals, Mr. Thompson said, "Sure, we will go as far as we possibly can." The six states for which the government released data today are Colorado, Florida, Maryland, Ohio, Rhode Island and Washington. The new data will be available on the Web at www.medicare.gov and through a toll-free telephone number, 800-Medicare (800-633-4227). For most nursing homes, the government will report six types of information: the proportion of residents who have bedsores, who are in physical restraints, who have lost too much weight, who are suffering pain, who have certain types of infections and who need more help with daily activities. Using the data, a family can see that, for example, 12 percent of the residents at Miami Shores Nursing and Rehabilitation Center have bedsores, compared with 37 percent at the Regents Park home in Boca Raton, Fla., 9 percent at the Hebrew Home of Greater Washington, in Rockville, Md., and 4 percent at the Josephine Sunset Home in Stanwood, Wash. The average for the six states is 8 percent. Tess Canja, the president of AARP, noted that the government was not disclosing data on the ratio of employees to patients or the number of consumer complaints about each home. But federal officials said they would eventually disclose those figures. Some nursing home owners and health care experts said the data could be confusing, and Secretary Thompson acknowledged that the project "is going to be very controversial." Dr. Andrew M. Kramer, a professor of medicine at the University of Colorado who advised the Bush administration on the effort, said, "Public reporting of quality-of-care information is a good idea," but he cautioned: "The current information is not adequately adjusted for differences in the health of individuals admitted to nursing homes. Therefore, the data could be misleading. They could make good homes look bad, and vice versa." Janet C. Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform, a consumer group, said the data would be helpful. But, she said, people choosing a home should also ask for state inspection reports and should visit homes to observe the quality of care. Federal officials and economists have been saying for years that health care markets would operate like other markets if consumers had more information. The new initiative will test that hypothesis. "The data will help us identify opportunities for improvement, areas where we can do better," said Mary K. Ousley, chairwoman of the American Health Care Association, one of the trade groups that endorsed the initiative. William L. Minnix Jr., president of the American Association of Homes and Services for the Aging, which represents nonprofit homes, said, "If substandard nursing homes don't improve, public pressure will drive them out of business." The statistics are based entirely on data that nursing homes report to the government as a condition of participating in Medicare and Medicaid. Homes that knowingly submit false information can be prosecuted for fraud. The government said it had adjusted the data to reflect the fact that some nursing homes had patients who were sicker or more frail than residents of other homes, though Dr. Kramer and some other experts said the adjustment had not been sufficient. The statistical methods used to make such adjustments are complicated and imperfect. Irene Fleshner, senior vice president of Genesis Health Ventures, a national nursing home chain, said the government's numbers did not "adequately portray the quality of care." But Dr. Jeffrey L. Kang, chief clinical officer at the federal Centers for Medicare and Medicaid Services, said researchers had found that the data provided "a fair reflection of nursing home quality." Because the government uses the same data for reimbursement, nursing homes have conflicting incentives: they receive higher payments if patients look sicker, but the quality of care appears better if patients look healthier. Dr. David L. Jackson, medical director of HCR Manor Care, which operates about 300 nursing homes, said, "None of the quality measures are perfect, but they are good enough to make this initiative worthwhile."
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