Update: Pay-For-Performance Coming to Nursing Homes

Nursing homes in AZ, MS, NY and WI had until May 1, 2009 to apply for participation in the Nursing Home Value-Based Purchasing demonstration project. Award letters are expected to be sent out around June 1st 2009 to 50 selected nursing homes in each state. Each nursing home then has 30 days from the date on their acceptance letter to accept. The project will begin in the summer and last for three years.

Even if your nursing home is not participating in CMS's demonstration project, you can still benefit by learning more about it. If the program is successful, it will be expanded to more states and participation will likely eventually become mandatory. Understand the quality measures used in the project and identify areas of improvement for your facility now so you'll be ready. This will give you the advantage of extra time that your competitors might not have had.

For more information about the demonstration or the quality measures used, visit http://www.nhvbp.com or contact Enovasis Healthcare Solutions.

Pay-For-Performance Coming To Nursing Homes

CMS is kicking off a five state pay-for-performance (P4P) demonstration project that will help them design incentives for quality improvement in nursing homes. They're calling it Nursing Home Value-Based Purchasing.

Arizona, Mississippi, New York and Wisconsin have been chosen to be the host states. Nursing homes in these states are invited to participate.

Basically how the demonstration project will work is over the next couple years CMS will collect quality data on participating nursing homes, assign scores based on performance and compare those scores to other nursing homes in the state overall and over time.

CMS will determine how much money is saved as a result of nursing homes' improvements and then allocate those cost savings to the best-performers in the form of incentive payments.

However if it is determined that nursing homes in a particular state did not improve overall, no incentive payments will be disbursed...no matter how well a particular nursing home performed.

If you're considering participating in the demonstration and would like assistance, Enovasis can guide you through it. Enovasis can also identify and implement improvements to increase the likelihood of receiving incentive payments. Contact us today.

For more information about the demonstration or to apply for participation visit www.nhvbp.com.

Reduce Readmissions by Discharging to Better Nursing Homes

In our experience, a common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in our neighborhood yielded surprising results. We found one in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.


Both of these indicators can be found on nursing homes across the country at WhereToFindCare.com. Simply search for nursing homes, click on the nursing home desired, click the Quality tab, then "See Details..." next to the Long Stay condition.

WhereToFindCare.com is working on a free tool to help you with this process. Join our mailing list to receive an update as soon as it is available.