Quality Measures

Nursing home quality measures have four intended purposes:

• To give you information about the quality of care at nursing homes in order to help you choose a nursing home for yourself or others;
• To give you information about the care at nursing homes where you or family members already live;
• To give you information to facilitate your discussions with the nursing home staff regarding the quality of care; and
• To give data to the nursing home to help them in their quality improvement efforts.

The nursing home quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. These measures assess the resident's physical and clinical conditions and abilities, as well as preferences and life care wishes. These assessment data have been converted to develop quality measures that give consumers another source of information that shows how well nursing homes are caring for their resident's physical and clinical needs.

The current quality measures have been chosen because they can be measured and don't require nursing homes to prepare additional reports. They are valid and reliable. However, they are not benchmarks, thresholds, guidelines, or standards of care. The quality measures are based on care provided to the population of residents in a facility, not to any individual resident, and are not appropriate for use in a litigation action.

These quality measures were selected because they are important. They show ways in which nursing homes are different from one another. There are things that nursing homes can do to improve their quality measure percentages. The quality measures have been validated and are based on the best research currently available. As this research continues, scientists will keep improving the quality measures on this website.

From the beginning of this initiative, CMS has said that the quality measures are dynamic and will continue to be refined as part of CMS's ongoing commitment to quality. In June 2011, the National Quality Forum (NQF) endorsed our 16 nursing home quality measures. NQF is a voluntary standard setting, consensus-building organization representing providers, consumers, purchasers and researchers. These nursing home quality measures will become the enhanced set of publicly reported quality measures available on Nursing Home Compare in the  summer of 2012.

The quality measure short stay and long stay definitions are:

• The short stay quality measures include all residents in an episode whose cumulative days in the facility is less than or equal to 100 days at the end of the target period.. An episode is a period of time spanning one or more stays, beginning with an admission and ending with either a discharge or the end of the target period (whichever comes first). A target period is the span of time that defines the QM reporting period (e.g. a calendar quarter).
• The long stay quality measures include all residents in an episode whose cumulative days in the facility is greater than or equal to 101 days at the end of the target period. An episode is a period of time spanning one or more stays, beginning with an admission and ending with either a discharge or the end of the target period (whichever comes first). A target period is the span of time that defines the QM reporting period (e.g. a calendar quarter).

The current nursing home quality measures are:

Short Stay Quality Measures

• Percent of Residents who Self-Report Moderate to Severe Pain
• Percent of Residents with Pressure Ulcers that are New or Worsened
• Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine
• Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine

Long Stay Quality Measures

• Percent of Residents Experiencing One or More Falls with Major Injury
• Percent of Residents who Self-Report Moderate to Severe Pain
• Percent of High-Risk Residents with Pressure Ulcers
• Percent of Long Stay Residents Assessed and Appropirately Given the Seasonal Influenza Vaccine
• Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine
• Percent of Long-stay Residents with a Urinary Tract Infection
• Percent of Low-Risk Residents Who Lose Control of their Bowels or Bladder
• Residents Who Have/Had a Catheter Inserted and Left in Their Bladder
• Percent of Residents Who Were Physically Restrained
• Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased
• Percent of Long-stay Residents Who Lose Too Much Weight
• Percent of Residents Who have Depressive Symptoms

Quality measure specifications are available in the MDS 3.0 QM Users’ Manual, which can be found under the download section below.

Development of Staffing Quality Measures Phase I

The Final Report from the Development of Staffing Quality Measures Phase I is available below in the download section. This report includes an Overview of the files, an Executive Summary, the Final Report and Appendices, the Nursing Home Staffing Database and Data Dictionary, the Literature Review, and the Stakeholder Meeting Summary. This phase of the project was completed July 2005. Development of Staffing Quality Measures Phase I Continuation currently underway is expected to conduct a feasibility study and test specified payroll data reporting. Updates on the current phase will be published on this page once available.

Pay for Performance

CMS has implemented a value-based purchasing demonstration for nursing homes in New York, Wisconsin and Arizona. The Nursing Home Value Based Purchasing (NHVBP) demonstration is part of a CMS initiative to improve the quality of care furnished to Medicare beneficiaries in nursing homes. This demonstration tests the "pay for performance" concept applied to the nursing home setting. CMS is assessing the performance of participating nursing homes based on selected measures of quality of care, and then make payment awards to those nursing homes that achieve a high level of performance or exceptional improvement based on those measures. Domains represented in the quality measures including staffing, appropriate hospitalizations, outcome measures from the minimum data set (MDS), and inspection survey deficiencies. CMS awards points to each nursing home based on how they perform on the measures within each of the domains. These points will be summed to produce an overall quality score. This three year demonstration began July 1, 2009. The following numbers of nursing homes were selected to participate at the beginning of the demonstration: Arizona - 41, New York - 79, Wisconsin - 62. CMS has not completed the evaluation of participants' performance during the first year of the demonstration.