Nursing Home Report Card Is Released by Government

By Robert Pear

NY Times, November 13, 2002

WASHINGTON— The government released data today to help consumers judge the quality of care at 17,000 nursing homes around the country, just six weeks after the federal government cut back payments to finance such care.

For each nursing home, the government is publishing up to 10 measures of performance or quality, including the percentage of residents who are in physical restraints or have infections, bedsores, pain or symptoms of acute confusion or delirium.

"This is a new approach," said Tommy G. Thompson, the secretary of health and human services. "Not only will consumers be better informed, but nursing homes themselves will be able to see more clearly what they must do to make the grade."

Publication of the data, for all nursing homes that participate in Medicaid or Medicare, expands on a pilot program begun in April in Colorado, Florida, Maryland, Ohio, Rhode Island and Washington State.

Federal officials said they intended to publish similar performance data for home health agencies next year. Report cards on hospitals and perhaps on doctors will follow, the officials said.

Donna R. Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform, a consumer group, welcomed the new information, saying it "shines a spotlight on the quality of care, which we know is substandard at many nursing homes." But Ms. Lenhoff cautioned that "consumer information cannot be a substitute for tough enforcement" of federal regulations.

Kary W. Hyre, the long-term care ombudsman for Washington State, said the data on nursing homes there had been "helpful to some consumers, but confusing and misleading to others." Publication of the data did not generate many inquiries from consumers, he said.

Trade groups for the nursing home industry endorsed the federal initiative. In the six states that received data in April, they said, many nursing homes used the information to identify and correct problems.

But nursing home operators said that Medicare payments were cut about 10 percent at the beginning of the federal fiscal year, on Oct. 1, despite pleas from the industry.

Medicare, which covers 12 percent of nursing home residents, pays an average of slightly more than $300 a day for each Medicare beneficiary in a nursing home. But Medicaid, the federal-state program that covers 70 percent of nursing home residents, pays an average of $105 a day, and states are cutting back Medicaid payments because of their fiscal woes.

Dr. Charles H. Roadman II, president of the American Health Care Association, which represents commercial nursing homes, said the Medicaid rate, averaging less than $4.40 an hour, was far too little to cover the costs of housing, food, prescription drugs, therapy, nurses and other employees.

"You can't even get a baby sitter for $4.50 an hour," Dr. Roadman said.

Asked whether nursing homes should receive higher federal payments, Secretary Thompson said: "Sure, they need more money. Everybody in the nursing home industry realizes that. I support them."

But nursing home executives said the Bush administration had not supported legislation to prevent or reverse the Medicare cuts that took effect last month. And it has opposed legislation to increase federal contributions to Medicaid.

Medicare pays private entities to investigate complaints of substandard care and to work with doctors, hospitals and nursing homes to correct deficiencies. These entities, known as quality improvement organizations, show nursing homes how to prevent and treat bedsores, how to manage pain and how to prevent falls.

The government said it was spending $2.3 million to publish comparative data on nursing homes in 71 newspapers this week. Detailed information is available on the Web, at www.medicare.gov. First-time users may have difficulty extracting information from the Web site, but may obtain help by calling a toll-free number, (800) Medicare (633-4227).

Data for each nursing home can be compared with the average for its state and for the nation as a whole. The proportion of nursing home residents with bedsores, for example, averaged 10 percent in California, 9 percent in New York, 5 percent in Iowa and 8 percent nationwide.

Many of the numbers were adjusted to account for the severity of a patient's illness. Otherwise, nursing homes might be penalized just because they treat sicker patients.