Testimony Before the National Commission for Quality Long-term Care
Dr. M. Keith Weikel, Alliance for Quality Nursing Home Care
July 22, 2005

Speaker Gingrich, Senator Kerrey and distinguished members of the Commission-
Let me begin by thanking you for your commitment to improving the quality of long-term care in this country and for volunteering to be associated with this Commission's important work. My name is Keith Weikel, and I'm here today representing the Alliance for Quality Nursing Home Care. The Alliance is composed of the nation's largest skilled nursing providers who have joined together in an effort to improve the quality of care in nursing homes.

Three years ago this month, the provider community launched an important and unprecedented initiative on quality. Known as Quality First, the initiative consisted of seven core principles that served as an essential framework to achieve meaningful progress on quality. The Alliance took those principles and "operationalized" them through a code of conduct and ethical management practices, which we refer to as the Quality First Pledge. We've submitted the Pledge with our testimony for your review.

Quality First built on the solid foundation created by the national Nursing Home Quality Initiative, introduced in 2001 by CMS. That initiative created a means to uniformly measure quality, and then disclose the results of those measures to the public. The Alliance was - and continues to be - wholly supportive of that program.

The question now is: Have these initiatives made a difference? The answer is an unqualified 'yes.' Government inspection data show that the Alliance companies have achieved an overall - and statistically significant - decline in deficiencies over the past three years, most importantly, in the area of severe deficiencies. Last December, CMS released performance results based on their new quality measures, and those results also show positive trends in the area of chronic and post-acute pain, as well as restraint use.

While government data provide important measures of progress, the Alliance has also spearheaded its own assessments. Just over a year ago, we commissioned a study of our progress in implementing the Pledge. That study found that Alliance companies had made meaningful progress in meeting their commitments. We've provided a copy of that report for the Commission's review.

As much as we wanted these assessments to show improvement, we also wanted them to identify areas for improvement - and they did: specifically the need to uniformly measure patient and family satisfaction. Based on those findings, the Alliance companies entered into a major contract - the first of its kind on a national level. Through the contract we will assess satisfaction using a common set of questions. Not only will this allow our companies to compare results, it also will allow us to benchmark performance. This type of non-clinical quality data is critical to ensuring patient well being, and we are proud to be leaders in this area.

Clearly, we are making steady improvement. Now we need to ask: what is necessary to ensure that quality continues to improve?

First, we need a stable funding environment in which to provide care. After the Balanced Budget Act of 1997, skilled nursing facilities were underfunded. Working with Congress and the Executive Branch, we have seen some funding restored, and this has helped to provide an environment where quality improvement is possible. Secondly, we must ensure that both providers and government keep their commitment to improving quality. Finally, we should explore proposals that link Medicare payments to nursing homes to the quality of care they provide. Such pay-for-performance systems will allow us to build on the current quality of care measures, develop new ways to give patients and families access to information on quality, hold providers accountable for the quality of care they deliver, and introduce a system of rewards and penalties based on performance.

Improving nursing home quality has been a true partnership between the health care community and the federal government. The National Commission on Quality Long-term Care now plays an important role as well. This Commission can and should help drive quality to new and higher levels by engaging in five key ways:

• First, by holding providers accountable. We pledged to improve quality, and we expect the Commission to hold nothing back in making sure we're meeting our commitments.
• Second, by recommending quality goals. On a national basis, we should be working together toward achievable and sustainable quality goals.
• Third, by helping to focus government and public attention on creating an environment where quality is encouraged, supported and rewarded.
• Fourth, by launching a public discussion about how our nation will pay for quality long-term health care in the future.
• And fifth, by calling attention to the rewards of careers in long term care. Because quality always goes back to one basic principle: people caring for people. We need more caring, qualified and committed staff in our nursing centers to continue making meaningful progress on quality.
  

Working together, skilled nursing providers and the government have made progress in the past three years, but there is more work to be done. We are eager to work with the Commission, and we look forward to your leadership in the months and years ahead.