Commentary
Shoshanna Sofaer, Dr.P.H. Baruch College School of Public Affairs
Key Take Away Messages
• Drivers of quality include:
– – – – Meaningful choice Decent reimbursement levels Meaningful regulations and standards Effective enforcement of regulations and standards – Information (not just data) about quality
June 6, 2004
Academy Health
2
Key Take Away Messages
• Meaningful choice requires
• • • • • Enough nursing home beds Options to nursing homes Variations in the options available At least some nursing homes with excellent qualiity Ability of patients and families to access comparative quality information at the point of choice • Participation by those traditionally seen as mediating or facilitating choice process
June 6, 2004 Academy Health 3
Key Take Away Messages
• Decent reimbursement levels
– The potential of “pay for performance” – What do low reimbursement levels imply about societal commitment? – Should states be the primary engine for financing long term care? – Do we really understand the process of resource allocation decision making within the nursing home context?
June 6, 2004 Academy Health 4
Key Take Away Messages
• Meaningful regulations and standards
– Do we have the evidence base to determine what really makes a difference in nursing home quality? What factors? At what threshold? – Should standards only focus on setting a reasonable floor? What does imply for the “information value” of regulatory decisions?
June 6, 2004
Academy Health
5
Key Take Away Messages
• Meaningful enforcement of regulations and standards
– Again the issue of societal commitment arises – The role of those served in this process is absolutely critical – Do we understand the relationship between enforcement and quality improvement – are they mutually exclusive and if not, how?
June 6, 2004 Academy Health 6
Key Take Away Messages
• Information (not just data) about quality
– We may well have way too much data and almost no information – Work to identify “indicators” rather than “measures” is critical – the results to date are disturbing because of signal lack of correlation across measures
June 6, 2004
Academy Health
7
Key Take Away Messages
• To be effective in driving quality, information must be
– Relevant to users (patients, family members, advocates, providers, regulators, purchasers) – Publicly reported in formats that are easily and accurately understood (evaluable) – Disseminated through media and channels that are trustworthy and really accessible to the audience in question
June 6, 2004 Academy Health 8
Key Take Away Messages
• If we are serious about quality, we have to use all the levers available to drive it, rather than choosing just one • This means supporting information for choice, payment incentives, regulation, and quality improvement efforts, not just one or the other
June 6, 2004 Academy Health 9