LONG-TERM CARE

Nursing homes, and R.Ph.s, come under new scrutiny

It's a good thing ... with a few caveats. That's the initial reaction from a variety of consultant R.Ph.s assessing the government's Web posting of selected consumer quality indicators for nursing homes. Six pilot states (Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington) led the way last month, when results on nine quality measures from 2,600 nursing homes certified by Medicare or Medicaid were posted on www.medicare.gov. Data from remaining states are scheduled for this fall.

Tim Webster, executive director of the American Society of Consultant Pharmacists, echoed the thoughts of many with his reaction to the consumer initiative: "Mostly positive, somewhat problematic because it's not a perfect process."

• What impact will this have on the facilities?

A major concern is that all nursing homes are not being treated fairly by the consumer quality indicators. As David Kazarian, Infuserve America, St. Petersburg, Fla., said, "My initial reaction was disappointment in the government; it gives only global numbers and not the whole story."

Lori Daiello, Pharmacotherapy Solutions, Orlando, Fla., added, "Taken out of context, it can be a problem." She is concerned that consumers will not interpret the information correctly. If a facility has a high number of residents with pressure sores, for example, consumers might shy away from that facility, not knowing it specializes in treating pressure sores, so its percentage is artificially high.

Sheldon S. Sones, The Sones Group, Newington, Conn., also fears the process may be flawed. "Acuity differences, focus-of-care differences [such as Alzheimer's treatment], compiled with demographics, may skew the findings and thus the relative performances."

Seattle-area consultant pharmacist Richard Molitor suspects that publishing comparative results will only enhance the workload of those in high-quality operations once demand for their facilities exceeds capabilities. "If regulators can throw some money the way of high-quality operations, that might be a potent incentive for others to improve," he said.

• Will consultant pharmacists be under increased scrutiny from the public or nursing home administrators and directors of nursing?

David Jones, director of utilization and outcomes management for NeighborCare, Baltimore, doesn't envision a greater level of scrutiny. It will be one more level of expectation, obviously, he said, but he thinks it will not have a major impact on what consultants are already doing.

On the other hand, said Sherrie Dornberger, director of nursing at Pitman Manors, Pitman, N.J., everyone will be under a more watchful eye. "I think consultant pharmacists will be under more scrutiny from the public. Looking at the quality indicator of nine or more meds, some laypeople won't understand that five or six of those might be vitamins. So we seem to be overmedicating, and why isn't the pharmacist doing more about it?"

Sones intimated that the new quality postings could have a greater impact on consultants who are doing less than an optimal job. "I am not sure that high-quality consulting services necessarily correlate to a favorable ranking. Mediocre service might set the stage for a cascade of unfavorable trends—and scoring."

At Seattle's Bailey-Boushay House, administrator Christine Hurley thinks the most obvious direct fallout on pharmacists will be in the area of pain management. "If it leads to increased attention to pain assessment and improved pain management, that would be wonderful."

Jason Reefer, administrator of Aspen Living Center, Colorado Springs, sees the postings affecting consultants only if the ratings put consultants under pressure to reduce the number of meds or change them. Then there's danger of people trying to manipulate the statistics.

• How can consultant pharmacists use this new initiative to their advantage for helping residents or enhancing the pharmacist's role?

Jones sees it as a "very powerful tool." If the facility has a concern in one of the [scoring] areas, the consultant could work with the residents on a correction. It could also be an educational tool, allowing the consultant to work with the facility itself on a specific area, such as pain management or pressure ulcers.

Said Molitor, "This puts pressure on consultant pharmacists to focus more on the patient and less on what the pharmacy's corporate folks want to impose in the way of formularies or 'top-down' patient management directives."

For Kazarian, it offers an opportunity for the good consultant. "If the consultant can monitor and show improvement as a direct result of his/her efforts, that's a great way to show the value of consulting services."

As for Webster, he sees the quality indicators "continuing to be important in highlighting and emphasizing the opportunity for consultant pharmacists to make a difference in this care setting."

Families without Internet access can call (800) 633-4227 for printouts of their states and counties.

Dana Cassell

The author is a writer based in New Hampshire.

Dana Cassell. Nursing homes, and R.Ph.s, come under new scrutiny.

Drug Topics

2002;10:65.