“I have measured out my life in coffee spoons,” Prufrock says in one of the great poetic kvetches of all time.
And there is surely a reason that our culture makes a cliché of the line that quality is more important than quantity.
But for Neil Pruitt Jr., there’s a revolution in the measurements, and quality vs. quantity is a false antithesis. “We’ve always been delivering quality, high-quality care in America’s long term care facilities,” Pruitt says. “The problem is you had so many initiatives… but nobody had said that we’re going to have some specific measures.”
Pruitt, leader of the long term care company that bears his family name, UHS-Pruitt Corp., headquartered in Norcross, Ga., is wrapping up two years as chairman of the American Health Care Association’s Board of Governors. In most cases, it would be sloppy to refer to a mere two years as an “era,” but Pruitt’s time comes the closest to deserving the term.
“Neil deserves enormous credit for bringing AHCA and the Alliance together and for making the delivery of quality care our core mission,” says AHCA board Secretary/Treasurer Leonard Russ.
Group Launches Quality Initiative Under his direction, AHCA/National Center for Assisted Living launched its Quality Initiative. The group set specific, measurable targets to improve care by safely reducing hospital readmissions, cutting back on staff turnover, increasing customer satisfaction, and cutting back on the off-label use of antipsychotic drugs.
“When we started that initiative, we decided that if we truly were going to be in partnership with CMS [the Centers for Medicare & Medicaid Services], quality truly had to be a concern,” Pruitt says. While there has been tension between CMS and the profession, Pruitt says that he and his colleagues recognized that, whatever differences they may have with regulators, they ultimately share the same goal—quality care. The idea is not just to meet regulators’ expectations, but to surpass them, thereby building up the credibility of the profession.
The regulators seem to have understood the effort. When the association launched its Quality Initiative, only 37 percent of its members were rated 4 stars or higher by CMS’ Five-Star Quality program. Now, it’s an even half. Perhaps even better, the 2-Star facilities decreased from 40 percent to 27 percent in just two years.
“None of us likes the Five-Star system, per se,” Pruitt says. “But we wanted our partners at CMS to know—if you give us a system, we can exceed it. Our members really started to move the ratings.”
It’s not just in the rating system. In July, CMS announced that long term care facilities had cut down on the improper use of antipsychotic drugs for those suffering from dementia by about 9 percent nationally. AHCA members had cut their uses by 10.5 percent.
“In fact, what we saw across the nation is that the state execs started aligning their quality initiatives with the national ones. And they started competing with one another,” Pruitt says.
AHCA President and Chief Executive Officer Mark Parkinson says Pruitt deserves a mountain of credit for his focus on data-driven quality.
“Neil has been a leader for our profession on many levels and in many respects,” Parkinson says. “And in each of them, he has stressed not just a broad vision, but specific, measurable goals with defined timelines to achieve and succeed. From our landmark Quality Initiative to new advances in LTC Trend Tracker, Neil has been truly transformational as he has shepherded these efforts during his tenure.”

Patients First

Pruitt’s intervention comes at the best possible time for the profession: An aging population virtually guarantees that long term care is going to be in the public’s eye. 
“Obviously, we have some work to do in getting the story out,” he says. “But if we take care of the patient, the story will take care of itself, time and time again…
“Not only have we said we want to move these markers of quality. We have AHCA dedicated staff; they’re out on the road, making sure they’re disseminating the best, evidence-based practices. If an AHCA member is serious about making improvements, they go to our website, they can check with our state affiliates, and it virtually is self-propelling.”
Pruitt renounces his formal title, but it’s doubtful that he’ll walk away from the work. In the meanwhile, he’s also serving on the Long Term Care Commission, which is charged with advising Congress on the best ways to care for an aging America.
“I will say that I have enjoyed the commission,” he says. “We do need to improve coordination and efficiency in the system. We don’t need to do it because of good government or saving money, but we need to do it because it’s good for the patient.”