Centers for Medicare & Medicaid Services;’ study aims to improve division of resources and quality of care at nursing homes

ANN ARBOR, MI —Brant E. Fries, Ph.D.” an innovator in the assessment of nursing home residents” has been selected to help lead a federal study that will gauge the resources used to care for various residents of nursing facilities.

Fries says the study will lead to a more equitable division of payments to nursing homes, based on the number of residents at the different ends of the cost spectrum. If a large number of patients at a nursing home require extensive care from staff members, for instance, the nursing home may be entitled to a greater share of funding than facilities with residents needing less care.

“By analyzing the information in such a way, we can divide the pie as fairly as possible,” says Fries, professor in the Department of Health Management and Policy at the University of Michigan School of Public Health, research professor in the Institute of Gerontology at the U-M Health System and chief, Health Systems Research, at the Veterans Affairs Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center.” Ultimately, this will help create an environment in which better-quality care is provided at nursing homes around the country.”

The study, initiated by the Centers for Medicare & Medicaid Services, or CMS, is known as the Staff Time and Resource Intensity Verification Project. The STRIVE project is the first nationwide time study for nursing homes conducted in the United States since 1997.

The study will collect information about residents such as health status, medical conditions, and services received, and facility resources used to provide care including staff time. Ultimately, the goal is to update the payment system for federally-funded Medicare skilled nursing facilities and to provide the states with the data they will need to evaluate and update their similar Medicaid payment systems.

CMS has contracted with the Iowa Foundation for Medical Care to perform this project. IFMC has assembled an expert team from around the country to conduct the study, including Fries, who will lead the data analyses effort.

For Fries, the current project is an offshoot of the work he has performed for years. His work in the area began in the 1970s, when he originated the concept of Resource Utilization Groups, a case-mix classification system for nursing homes. The newest version he developed, RUG-III, is used for Medicaid payments in more than half of all states and was adopted in 1998 by CMS for the national Medicare Prospective Payment System. He also helped develop the Resident Assessment Instrument, a federally mandated system, implemented nationally in 1991 that currently provides information about approximately 3.7 million nursing home residents per year. He has also analyzed preliminary RAI data, finding, for example, that physical and chemical restraints increase the cost of care and decrease quality of care.

CMS plans to use the data from the STRIVE study to adjust the current case-mix weights created using the RUG system. CMS also hopes to partner with state agencies and nursing home associations on the STRIVE data collection.

A systematic way of analyzing nursing homes has always been important, perhaps never more so than now, when the population is aging at a rapid rate, Fries says.” It is vital that we ensure a high quality of care for elderly and disabled persons, wherever they are being cared for,” he says.

In addition to Fries, IFMC has contracted with: Robert Godbout, Ph.D., of Stepwise Systems Inc.; David Malitz, Ph.D., of Stepwise Systems Inc.; and Dave Oatway, M.P.H., of CareTrack Systems LLC. A pilot study of the data collection systems and procedures is scheduled for late winter 2006. Data collection is scheduled to begin in spring 2006, for completion in spring 2007. Thorough analysis of this data will continue through winter 2007, and recommendations are expected in late 2007 or early 2008, according to CMS.