Jonathan BlumThe long term and post-acute care industry needs to hold the Centers for Medicare & Medicaid Services (CMS) accountable for its inconsistencies, Jonathan Blum, deputy administrator of the agency, told the 425 attendees at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Quality Symposium in February.
“Where we need your help, and where you need to come to us, is when you see one part of CMS not operating consistently with the others,” he said.
“We are a large bureaucracy, so if you feel at any time the payment policies we are promoting are not consistent with what we’re trying to achieve on the quality side, on the survey and cert side, those are opportunities to come to us and say, ‘Hey guys, get this right.’”
Blum addressed the two-day conference during its opening session, just after Gov. Mark Parkinson, AHCA/NCAL president and chief executive officer, and Neill Pruitt Jr., AHCA chair, had outlined its new Quality Initiative (see Provider’s March issue, page 38, for details) and its four measurable goals.
Initiative Goals AHCA/NCAL Quality
Safely Reduce Hospital Readmissions. By March 2, 2015, at 12:00 p.m., reduce the number of hospital readmissions within 30 days of a skilled nursing stay by 15 percent.
Increase Staff Stability. By March 2, 2015, at 12:00 p.m., reduce turnover among clinical staff (registered nurse, licensed vocational nurse, licensed practical nurse, certified nurse assistant) by 15 percent.
Safely Reduce the Off-Label Use of Antipsychotics. By Dec. 31, 2012, at 12:00 p.m., reduce the off-label use of antipsychotics by 15 percent.
Increase Resident Satisfaction. By March 2, 2015, at 12:00 p.m., increase the number of customers who would recommend the facility to others up to 90 percent.
As Blum took to the podium, he commended Parkinson and Pruitt for their leadership in recognizing CMS as a partner and “not an adversary,” as Parkinson noted in his opening statement. “It is inspiring at CMS that you see us as a trusted partner,” Blum said to attendees. “I’d like to thank you, to commend you. From our perspective, we couldn’t be more pleased and more proud of you. There will be no disagreement regarding the overall quality goals.”

With that, Blum described the three-part aim that is guiding CMS’ work, as follows: better care, better health, and lower cost through improvement. In addition, he highlighted six “tangible, overarching goals” the agency hopes to achieve inside of the three-part aim, which he noted fit “very well” with

AHCA/NCAL’s goals:
1. Reduce health care-acquired conditions. “We are trying to focus on reducing harm to patients while they are in facilities,” Blum said. “We also want to reduce the number of adverse medication events and reduce inappropriate antipsychotic use, which is why we are so pleased to see that this is one of your quality goals,” he said.

2. Reduce fragmentation in the health care delivery system. Blum noted that the current health care delivery system has silos of care. “And sometimes that care is not very coordinated,” he said. “One of our key goals is to reduce fragmentation, which led to CMS focusing on reducing hospital readmissions.” In addition, CMS is focusing on bundled payments to create stronger incentives for providers to take a much more integrated approach to care.

3. Create a health care system that has the capacity to capture and act on patient-reported information. “It is a fair observation that CMS tends to think of its world as payment, dollars, and survey information,” Blum said.

“We’re trying to change that to what the patient needs. We are building payment structures and care structures that focus on what patients need, what patients want, and how they navigate through the health care system.” Blum noted that the goal is to change care structures to encourage a health care delivery system that focuses on “patient-centered, best-quality outcomes at the lowest possible cost.”

4. Prevent and reduce harm to patients who have cardiovascular disease. This includes increasing blood pressure control, reducing high cholesterol, keeping patients healthier, and focusing on preventing chronic conditions, Blum said.

5. Encourage and promote innovation in local communities. CMS is supporting and nurturing local initiatives and systems throughout the country, Blum said, noting that one policy example the agency is focused on is supporting sites that want to integrate dual-eligible populations.
CMS’ new Center for Medicare and Medicaid Innovation is providing opportunities to spur local innovation, Blum added.

6. Identify and define measures that can serve as indicators of cost reduction. “Part of the reason care is not coordinated is because of the financial payment system we have in place,” Blum said.

“So, part of our goal, our mission, is also to focus on reducing costs, to lower costs through improvement.”

He noted that CMS would like “to prove to the world that lower cost, more trust fund solvency, if you will, will come not from just cutting market basket rates or cutting payments, but through better-managed care, better-coordinated care, and providing better transitions for our beneficiaries.”

In conclusion, Blum noted that the six goals he outlined are “very consistent” with the goals that Parkinson had outlined in the organization’s Quality Initiative. “This is where our partnership can work really well together,” he said.

The Quality Initiative goals that Blum commended were hashed out by board members and AHCA/NCAL staff during a two-day retreat, Pruitt told attendees during the opening session.

“We spent the first two days of our meeting—we didn’t talk about policy, Washington politics, or elections—we sat down and discussed quality and how it can make a difference in the buildings and patients we serve,” Pruitt said.

“We wanted quality to be an expectation, not just something we talk about. We wanted to think differently; we wanted to embrace the spectrum of services. We wanted to talk about technology and dashboards as a quality improvement tool. And we wanted it for all members regardless of size or profit or nonprofit status.”