Docstoc

The Nursing Home Performance Index

Document Sample
The Nursing Home Performance Index Powered By Docstoc
					Nursing Home Performance Index

NOVEMBER 13, 2008

Neil Gulsvig
President and Chief Executive Officer

neil@myinnerview.com 715-848-2713

A NURSING HOME PERFORMANCE INDEX?

WHY

Rationale behind the Performance Index
» Limitations of traditional quality metrics
» Realigning stakeholder values » Shifting from quality assurance to quality improvement models » Monitoring systems that drive performance

Rationale behind the Performance Index
» Providing comprehensive benchmarks to consumers
» Creating greater transparency and accountability for payers » Focusing funding priorities through new value propositions

» Developing a strategic compass for value-based purchasing initiatives

A NURSING HOME PERFORMANCE INDEX?

WHY

To tell the story of

WHAT MATTERS MOST

We all form opinions and make decisions based on the information available

Who is telling your story of what matters most?

»The media

Who is telling your story of what matters most?

»The media »Kaiser

Nursing homes provide high-quality services for people who need them
Don’t know/Refused

Strongly agree

10% 12%
Strongly disagree

19% 38% 21%
Somewhat agree

Somewhat disagree
Source: KFF Update on the Public’s View of Nursing Homes and Long-Term Care Services (conducted October 1 – October 10, 2007)

Perceived Quality of Nursing Homes

Source: KFF Update on the Public’s View of Nursing Homes and Long-Term Care Services (conducted October 1 – October 10, 2007)

Preferences for Long-Term Care

Source: KFF Update on the Public’s View of Nursing Homes and Long-Term Care Services (conducted October 1 – October 10, 2007)

Who is telling your story of what matters most?

»The media »Kaiser »Health Grades

Health Grades

Who is telling your story of what matters most?

»The media »Kaiser »Health Grades »State government

Minnesota

Who is telling your story of what matters most?

»The media »Kaiser »Health Grades

»State government »CMS

FIVE STAR RATING

Coming in December

World is changing in the way and the speed at which we get information
Number of people on-line

Number of Web pages

DOUBLE
every

1998

2008

3 months

Demographics of internet users
Age Use the internet

30-49 50-64

85% 72%

65 +

37%

Consumers want information
Quick

Easy to use
Clear and concise

8 out of 10 internet users say they have used the internet to look for health/medical information

74% say they felt reassured that they could make the appropriate healthcare decision

“Deal with the world as it is, not how you’d like it to be.”

JACK WELCH

Measure or be measured

Nursing Home Performance Index: Index Scores

Consumer Growth Prospects Presidential Sentiment AcademicQuality ConsumerPerformance Consumer Quality EconomicConfidence ConsumerOptimism NutritionalComfort National Mass ConsumerQuality Water Outlook Body Leadership Air Price

INDEX
Index

Consumer Price Index
Consumer Confidence Index

Body Mass Index
Air Quality Index Water Quality Index Consumer Growth Prospects Index National Outlook Index Presidential Leadership Index

Academic Performance Index
Consumer Comfort Index

Consumer Sentiment Index
Nutritional Quality Index Economic Optimism Index

Design principles
» Simple to understand
» Relevant measures

NURSING HOME PERFORMANCE INDEX:

» Realistic number of measures » Ease/availability of data » Actionable

Process

NURSING HOME PERFORMANCE INDEX:

» Research team
» Tested multiple metrics » Tested multiple models » Provider ―expert‖ validation » Subject matter ―expert‖ validation

» Consumer validation

Research Team
» Leslie A. Grant, Ph.D.
» Jean M. Abraham, Ph.D. » Michael Davern, Ph.D. » Brad Shiverick, C.P.H.Q. » Eric Lewerenz, M.S.

» Amy Hu, M.S.

Rigorous scientific tests
» Tested over 30 different index models using different metrics, weights and risk adjustment strategies » Invested hundreds of research hours to conduct exploratory analyses and reviewed over 1,000 pages of computer output

Rigorous scientific tests
» Completed extensive array of statistical tests using real data collected from federal, state and My InnerView data files » Developed state-of-art index for nursing home quality grounded in rigorous and valid scientific methods

4 Step Methodology
Step

1
Step

Select key metrics

What are the key metrics that define quality? How can different metrics be scored and combined into a quality index? What’s the relative merit of each metric? How can metrics be adjusted to reduce bias and create a ―level playing field‖?

Mandatory

2

Score metrics

Mandatory

Step Assign weights

3
Step

to metrics Risk adjust metrics

Optional

4

Optional

RECOMMENDED METRICS
Resident and Family Satisfaction

24-item resident and family satisfaction score
(Composite score)

Employee Satisfaction

21-item employee satisfaction score
(Composite score)

Workforce

Average monthly %: CNA stability, Nurse stability, CNA turnover, Nurse turnover 13 clinical measures for long-stay residents

Clinical

(Daily activities (decreasing), physical restraints, pressure ulcers (high-risk), influenza vaccination, pneumococcal vaccination, severe/moderate pain, depression/anxiety, incontinence, catheters, time in bed/chair, decreased mobility, urinary infections, weight loss)

Regulatory

Weighted survey deficiency score
(OSCAR)

My InnerView focus groups
» Triangulated & tested questions to find what really matters to stakeholders
» 35 focus groups across the country

» Respondent groups include long- and short-term residents, family members and discharge planners

LEVEL OF “IMPORTANCE” TO FAMILY MEMBERS
MOST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability

38% 6% 19% 31% 6%

Clinical indicators
Survey results

LEAST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability Clinical indicators Survey results
Source: Focus groups conducted by My InnerView, 2008

0% 20% 7% 7% 67%

LEVEL OF “IMPORTANCE” TO LONG-TERM RESIDENTS
MOST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability

75% 6% 6% 11% 3%

Clinical indicators
Survey results

LEAST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability Clinical indicators Survey results
Source: Focus groups conducted by My InnerView, 2008

0% 13% 10% 27% 50%

LEVEL OF “IMPORTANCE” TO SHORT-TERM RESIDENTS
MOST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability

56% 8% 10% 23% 3%

Clinical indicators
Survey results

LEAST IMPORTANT
Resident/Family satisfaction Employee satisfaction Workforce stability Clinical indicators Survey results
Source: Focus groups conducted by My InnerView, 2008

7% 17% 8% 11% 57%

EMPLOYEE METRIC

Relationship with resident

Relationship with resident

Relationship with resident

Number of CNAs/Call lights
Stability

Number of CNAs/Call lights
Clinical expertise and training

Number of CNAs/Call lights
Clinical expertise and training

Source: Focus groups conducted by My InnerView, 2008

Recent Trends in Value-based Purchasing (VBP)

Source: Optimizing Nursing Home Value in an Era of Diminishing Resources (2008, My InnerView)

Source: Optimizing Nursing Home Value in an Era of Diminishing Resources (2008, My InnerView)

Things to avoid
» Outdated data without real-time value

» Insensitive measures that are static
» Narrowly focused metrics (over emphasizing state survey results) » Misalignment of consumer, payer and provider needs or interests

» Inadequate stakeholder input

PERFORMANCE INDEX VS. FIVE-STAR
PERFORMANCE INDEX Composite and weighted FIVE-STAR Uncertain

Customer and resident satisfaction
Staff satisfaction

No but potential for future
No

Workforce
Quality measures (13) Regulatory — weighted

Staffing levels
Quality measures (19?) Survey results

RECOMMENDED METRICS
Resident and Family Satisfaction

24-item resident and family satisfaction score
(Composite score)

Employee Satisfaction

21-item employee satisfaction score
(Composite score)

Workforce

Average monthly %: CNA stability, Nurse stability, CNA turnover, Nurse turnover 13 clinical measures for long-stay residents

Clinical

(Daily activities (decreasing), physical restraints, pressure ulcers (high-risk), influenza vaccination, pneumococcal vaccination, severe/moderate pain, depression/anxiety, incontinence, catheters, time in bed/chair, decreased mobility, urinary infections, weight loss)

Regulatory

Weighted survey deficiency score
(OSCAR)

Thank you!

715-848-2713 | www.myinnerview.com

Questions?
www.myinnerview.com

715-848-2713


				
DOCUMENT INFO