CMS's long-term view is that there would be standardized quality measures of care across the entire spectrum - every site and every major subset of healthcare, including rehab. Results would be shared publicly, and those providing superior care would receive extra recognition from the Medicare program. Right now, in the hospital setting, Medicare is testing some models of providing bonus financial payments for superior quality care.

Currently they are quite good. Several have a risk adjustment so facilities that accept a sicker patient population are not penalized. However, it would be beneficial if some of the measures were framed in the positive rather than the negative. For example. for the hospital and some health settings, CMS reports quality to the public as measures of success rather than of failure. Providers will reach higher to achieve superior quality if they are chasing even-higher measures of success.

CMS posts 14 QMs on its Web site. While facilities should look at all measures, there's a tremendous opportunity to partner with a rehab provider to make improvements in those measures specific to falls, weight loss, mobility, and pressure ulcers. For example, rehab can help identify some of the causes of weight loss, such as problems with swallowing or positioning. A strengthening program can help decrease falls. Rehab can also help a facility identify those residents at risk for falls and create appropriate interventions. Also, the partnering of nursing and rehab staff in dementia management can really make a difference in success with QMs.

Excellence in rehab is absolutely integral to excellence in QIs and QMs. The nursing home should have an active and thoughtfully developed quality assurance structure that includes therapy. Therapists should be fully engaged in discussions about such issues as falls and about patients who are bedfast, who have worsening mood, or who have a decline in ADLs. The rehab team should be thinking of new ways to provide care so that patients can achieve the highest level of functioning possible. One of the system changes a nursing home can make to improve clinical quality is to provide higher quality rehab services - for example, partnering with a company or using a program that measures and shares outcomes. In simply hiring such a team, the nursing home will help ensure delivery of higher-quality care and improved performance on a number of QMs, as well as indicate that the nursing home cares about quality.

Measurements in and of itself helps to improve quality - it shines a light. Using standardized measures to help to improve quality because the facility can compare itself in a standardized way to other facilities.