If your nursing home is looking for new ways to improve its star rating from the Center for Medicare and Medicaid Services (CMS), a good place to start is your quality measures. You may think that you’ve done all you can to meet them. But many of your peers are finding new and creative ways to improve the care that they provide to their residents. You can, too.

As you know, quality measures are one of three “domains” that the CMS uses to decide how many stars your nursing home gets from the agency’s star rating program. You can earn as many as five stars based on how well you perform in those three domains.

The other two domains are the health inspection domain, which is how well you do on your three most recent health inspections, and the staffing domain, which is how well you meet the CMS’ standards for staffing your nursing home with qualified nurses, aides and other caregivers.

Why you should target quality measures

The health inspection and staffing domains certainly are as important as the quality measures domain. But they are less variable than the quality measures domain: the things you have to do to meet them fall within a narrow range. By comparison, the quality measures domain is much more variable. The things that you have to do to meet it fall across a wide range. As a result, how you do on your quality measures can have a big effect on your star rating one direction or the other.

And star ratings do matter. A new study from the National Bureau of Economic Research found that patients who go to skilled-nursing facilities with higher star ratings have lower mortality rates, spend fewer days in the nursing home and have fewer hospital readmissions.1

It’s clear that what your nursing home does to improve its scores on its quality measures really does matter. Not just to your star rating but to whom it should matter most: your patients.

Five ways to improve your quality measures

There are 17 measures in the quality domain. Ten measures apply to long-stay residents, or nursing home patients whose stays are longer than 100 days; seven measures apply to short-stay residents, or nursing home patients whose stays are 100 days or less. Improving performance on these measures can result in a higher star rating for your nursing home.

Below are five overarching strategies or tactics your nursing home can use to move the needle in the right direction on all 17 measures.

1. Engaged leadership. Culture starts at the top, and your nursing home is no exception. Quality improvement and quality measure reporting must be a priority for your executives and your senior management. They need to convey their priorities to staff and residents by regularly engaging and interacting with them. If they show that it’s important to them, it will be important to everyone who works and stays at your nursing home.

2. Staff participation. When I say everyone who works at your nursing home, I mean everyone. Quality improvement and quality measure reporting isn’t just for your nurses or your nursing assistants. You should cover everyone in your quality assurance and performance improvement, or QAPI, plan. That includes your dietary, housekeeping and maintenance staffs. Anyone who influences a patient’s care directly or indirectly must be on board.

3. Holistic care. By including everyone in your QAPI plan, you’re taking a holistic view of your patients. That’s the definition of patient-centric care. You’re focusing on medical aspects of their care and on all the other things that can affect their health status and health outcomes. You need to see the whole patient. Things like nutrition, mobility, socialization and independence can be just as important as the drugs that they’re taking.

4. Staff education. The CMS didn’t pick the 17 measures out of a hat. It picked them because it believes that how you do on those measures reflects the quality of the care that you provide to your patients. Your staff needs to know what those measures are and what the best practices are that map to those measures. They must have the competencies to execute on those best practices, and you need to validate their skills and knowledge on a regular basis.

5. Effective products. Your nursing homes should provide your staff with the right medical supplies and equipment to execute on those best practices that produce the best health outcomes for your patients. Not only do they need the right medical supplies and equipment, they need them at the right time. The health of your nursing home patients can be very fragile. Even a short delay in diagnosis and treatment can send them downhill in a hurry.

Now let’s look at how you can apply those ideas in new and creative ways to improve your scores on some specific and particularly challenging quality measures.

Providing better wound care

One quality measure for short-stay residents is the percentage of your patients with pressure ulcers that are new or worsened. Your staff education program should produce nurses with superior wound assessment and keen observation skills. They should know these three things:

  • If a patient had a wound prior to admission
  • If the wound occurred after admission
  • If the wound got worse during their stay

If the wound happened before admission, it would not count against your score on that measure. If it happened after admission, you could prevent the pressure ulcer from getting worse with the right wound care treatment and products—both administered immediately upon diagnosis. Again, stopping a wound from getting worse would not count against your score on that measure.

Preventing and treating infections

A quality measure for long-stay residents is the percentage of your patients with urinary tract infections. Infections are a leading cause of hospitalizations and readmissions of nursing home patients—two other quality measures. In this case, having the right products at the right time is crucial. You should be able to do point-of-care testing, in this case, a urinalysis to test for an infection. Not only are you taking a urine sample, but you’re using an analyzer on site to determine the results.

Here, staff education comes into play again. You should have an antibiotic stewardship program in place to match the patient’s test results with the antibiotic to treat their infection. Taking staff education a bit further—or, in this case, backward in time—you should have an effective bladder training program in place. Part of the program should be incontinence assessment which may include the use of a bladder scanner. This will help you to determine what type of incontinence the resident has. That can reduce or eliminate catheter use (another quality measure) that can lead to infections.

Proper nutrition can affect a patient’s ability to fight infections. Here’s where your holistic approach to care comes into play. The dietary program at your nursing home should be culturally sensitive. By that I mean offering different types of food or different food preparations that meet certain religious or ethnic protocols. Nutritionally sound and culturally sensitive meals could help a patient recover more quickly.

Benefits to your nursing home

The benefits to your nursing home from applying these five ideas to your quality measures come from the health of your patients. It used to be, once you went to the nursing home, that’s where you stayed until end of life. That’s not the case anymore. Today, if you go the nursing home, the goal is to get you as healthy as possible so you can go home again.

Your nursing home can do that by creatively applying those five techniques to each quality measure. Not only will your patients’ health improve, so will the health of your business. Higher scores translate into more stars, and more stars mean more referrals from hospitals, physicians and families.

Related: Learn more about McKesson’s clinical resources for nursing homes

Source: 1Do Report Cards Predict Future Quality? The Case of Skilled Nursing Facilities, National Bureau of Economic Research, 2019

Author Patty Baicy

About the author

Patti Baicy is the director of the clinical resources team for McKesson Medical-Surgical Extended Care. In her current role, Patti is responsible for leading our clinical team which supports our EC customers with education, formulary development and regulatory updates. Patti has been with McKesson for more than 18 years, focusing on clinical needs of our customers and product development of our McKesson Brand portfolio. She is a Registered Nurse with a Diploma in Nursing from Johnston-Willis Hospital School of Nursing.

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