Fact Sheet: Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries

Today, the Administration announced new executive actions and the President signed into law legislation that will improve the quality of care for nursing home and home health patients. The President signed the Improving Medicare Post Acute Care Transformation Act of 2014 (IMPACT Act), bipartisan legislation that puts in place new and streamlined quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare. The Administration also took additional steps to improve care for nursing home and home health patients through new executive actions that will:

• Expand and strengthen Medicare's widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare.
• Improve quality home health care received by Medicare beneficiaries through a proposed rule that strengthens patient rights, improves communication, and focuses on patient well-being.

Actions to Improve Medicare's Five Star Quality Rating System for Nursing Homes

Today, the Administration announced plans to expand and strengthen Medicare's widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare. The rating system is a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in Medicare or Medicaid. Users may sort through nursing homes in their area through an online tool at CMS' Nursing Home Compare website.

The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health departments and CMS; Quality Measures submitted by the nursing homes is used to calculate certain quality measures, such as the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls; and information about the staffing levels in nursing homes.

While the onsite inspections form the core of the rating system, CMS has been concerned that the quality measures and information about staffing levels rely on self-reported data from nursing homes that have been difficult to verify.

Beginning in January 2015 CMS will initiate the following steps to improve the reliability and utility of data displayed on Nursing Home Compare as well as to help nursing homes improve:

• Nationwide Focused Survey Inspections: In FY 2014 CMS piloted special surveys of nursing homes that focused on verifying performance on resident assessments and the data set that is used in the quality measures. Effective January 2015, CMS and states will implement these focused survey inspections nationwide for a sample of nursing homes nationwide. Expansion of these inspections will enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
• Payroll-Based Staffing Reporting: Using new funding provided by the IMPACT Act of 2014, signed by the President today, CMS will implement a system of quarterly electronic reporting that is auditable back to payrolls to verify staffing information. This new system will increase accuracy, improve the timeliness of the data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing. This data will not only allow for better information available to the public, but may equip nursing homes with better data by which to improve staffing and quality of care. CMS expects that pilot testing will occur in fiscal year (FY) 2015, with nationwide reporting by all nursing homes by the end of FY2016.
• Improved Scoring Methodology: CMS will revise the scoring methodology by which we calculate each facility's Five Star rating. The revised scoring methods will place more emphasis on data that is verified by independent sources rather than data that is self-reported by nursing homes.

• Timely and Complete Inspection Data: CMS will also strengthen requirements to ensure that states complete inspections of nursing homes in a timely and accurate manner, and maintain a user-friendly website for public viewing.

• Additional Quality Measures: CMS will increase both the number and type of quality measures used in Nursing Home Compare. The first additional measure starting January 2015 in the ratings system will be the extent to which anti-psychotic medications are in use. More measures will be added later, including data on re-hospitalization and rates of returning beneficiaries to home that use Medicare claims as the source of information.

Actions to Improve Quality Home Health Care Received by Medicare Beneficiaries

In conjunction with today's efforts to improve the quality of care received by Medicare beneficiaries in nursing homes, the Centers for Medicare & Medicaid Services today issued a proposed rule that strengthens patient rights, improves communication, and focuses on patient well-being. These rules are designed to improve the quality of home health services for Medicare beneficiaries.

These updates to home health agency conditions of participation (CoPs) make substantial revisions to the existing CoPs. They focus on the care needs of patients and will clarify the operational and quality expectations for the approximately 12,500 home health agencies participating in Medicare. There are more than five million people with Medicare and Medicaid benefits who receive home health care services each year.

The proposed regulation, will include these proposed updates:

• A clear explanation of patient rights, including a requirement to communicate with patients in a language and manner that they understand, and a requirement that home health agencies must take measures to assure and protect those rights.
• An expanded comprehensive patient assessment requirement that focuses on all aspects of patient well-being.
• An integrated communication system, increasingly enabled by health information technology, that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active, timely, needs-based communication between the home health agency and the physician.
• A data-driven, agency-wide quality assessment and performance improvement program that continually evaluates and improves agency care for patients.
• An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient's needs at all times.

Comments and feedback are requested to inform final rulemaking in 2015.

IMPACT Act

The President signed the Improving Medicare Post-Acute Care Transformation Act of 2014, bipartisan legislation that puts in place new and streamlined quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare.

The Act will facilitate patients comparing outcomes across different care settings, supporting better choices and better outcomes for patients. In addition, the IMPACT Act funds a key improvement to nursing home oversight, the collection of staffing data. Nursing and other staffing levels are closely correlated with quality in nursing homes and current data collection efforts have produced data of uneven reliability. The IMPACT Act also institutes more routine surveys of hospice providers, ensuring program standards are met for the benefit and safety of patients.