Research & Policy Analysis

CMS Integrated Chronic Disease Quality Performance Measurement at the Level of the Physician’s Office

The goal of the project as a whole was to define overall quality measures of physician performance with respect to chronic disease management and preventive care for older adults and to define strategies for quality improvement and physician recognition programs. Products that resulted included models of quality of care for diabetes and chronic disease care for older adults, a report on strategies for aggregate quality scoring, a report on chronic conditions among older adults and the definition of priority conditions for the model, and a report on lessons learned on physician performance measurement and reporting.

CAHPS II (Consumer Assessments of Health Plans and Providers Study)

The Consumer Assessments of Health Plans and Providers (CAHPS) is one of the Agency for Healthcare Research and Quality’s most important ongoing programs. CAHPS II initiated a shift in focus from assessment of health plans to assessment of providers. Three organizations – AIR, Harvard and RAND – are continuing to develop instruments and materials to assess the performance of plans and providers from the perspectives of beneficiaries and patients. Assessment results will be reported to consumers in order to help them make more informed choices and to plans and providers in order to help them improve quality.

Gerontology Expert Consultants and Witnesses for CMS for the Administrative Hearing Process

CMS has dramatically increased their critical role in the maintenance of standards for quality and safety of nursing home care. Because of this, there has been an increase in the number of identified deficiencies and an increase in the number of citations issued to non-compliant long-term care facilities. AIR assists the CMS and Office of General Counsel by developing an expert witness system that identifies, recruits, selects, and maintains a network of such expert witnesses to support actions against nursing facilities in violation of acceptable practices.

Medicaid Support for Community-Based Health Services

AIR provided research and technical assistance in Medicaid payment for mental health services. State Medicaid policymakers and administrators were informed about mental health care and the way Medicaid rules often erect barriers, so that they can work to remove those barriers. In addition, consumers and providers of community-based mental health services were informed about Medicaid eligibility and payment rules so they can become more effective at obtaining Medicaid payment for covered services.

Smoking and Drug/Alcohol Use Policies in Substance Abuse Treatment

There has been increasing interest in implementing smoking policies and services in drug/alcohol treatment facilities due to factors such as the high prevalence of smoking among drug/alcohol abusers and the recognition that these individuals are particularly susceptible to the negative health consequences of their addictions. This project, which is funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program, will improve upon existing studies by surveying a large, nationally-representative sample of adult inpatient and residential drug/alcohol programs.

Clinical Standards Repository Expansion

In 1998, the CMS Nursing Homes Branch created a web site repository containing summaries of nationally accepted clinical standards and guidelines. AIR, with the help of a clinical consultant (a retired nurse and former CMS employee) is identifying, collecting, and processing new and revised information for inclusion on the web site. We are expanding and updating the content on the site and creating a new AIR-managed web site containing the new repository. The newly updated web-based repository will serve as a reliable resource to long-term care surveyors who are evaluating facility care and services as well as to facility staff who are concerned with providing the best possible care and quality of life to nursing home residents.

CMS Performance Standards

CMS monitors the quality of State Survey Agencies’ activities by requiring them to meet seven Performance Standards covering things like whether survey findings are supportable, and whether certifications are fully documented and consistent with applicable law, regulations, and general instructions. AIR evaluated the Performance Standards, and produced a revised set of Standards and measures, in addition to policies for dealing with States that fail to meet the Standards.

Criteria for Acceptability of Quality of Care of Long-Term Care Facilities

This project aims to improve the ability of States to monitor the quality of care in long-term facilities in an efficient, objective, standardized, and reproducible manner. AIR developed and validated improved measures and instruments for multiple aspects of quality of care.

Development of Tag Guidance Project

CMS has contracted with State survey agencies to conduct nursing home inspections, involving the uncovering of deficiencies in nursing home operation and identifying their scope and severity. AIR p rovides survey teams with assistance in evaluating nursing homes and nursing home care in a manner that facilitates the gathering of sufficient, relevant information to support enforcement decisions, and ensures that severity ratings of the same deficiencies will be consistent from State to State.

Evaluation of The CMS Hospital Program

CMS has several methods for ensuring that hospitals receiving Medicare funds comply with Federal requirements. One is to contract with State Survey Agencies to conduct inspections of the providers, while the other is to accept accreditation by a hospital accreditation organization (AO), such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in lieu of state inspections. To monitor quality in the latter program, CMS has a “Hospital Validation Program” for assessing whether JCAHO’s accreditation provides reasonable assurance that accredited hospitals comply with Federal requirements. AIR analyzed the Revised Hospital Validation Improvement Program and proposed revisions to improve procedures for monitoring the performance of accrediting organizations in ensuring that providers comply with Medicare requirements.

Improving the Federal Oversight/Support Survey (FOSS) Process for Fiscal Year 2002

As a part of its strategy for monitoring the performance of State Agency nursing home inspectors, CMS uses a Federal Oversight/Support Survey (FOSS) in which Federal surveyors observe and critique a state team’s conduct of the survey. The project was a collaborative effort between AIR and a CMS Working Group. Under AIR’s leadership, this team reviewed the strengths and weaknesses of the original FOSS and developed a protocol for observing and scoring the state agency inspection teams. The FOSS was then implemented nationwide, and AIR evaluated the implementation based on surveys of FOSS evaluators, analyses of FOSS data, and focus groups with state and CMS regional office personnel. Based in part on findings from the evaluation, we are currently working with CMS to design and implement additional training for evaluators.

Organizational Culture and Drug Abuse Treatment Quality

The goal of this project is to develop measures that can be used to assess various aspects of the quality of care provided to agency clients. Specifically, the scales will measure staff behaviors that either improve or detract from the quality of care provided to clients. A secondary goal of the project is to determine how variables such as organizational culture, stress, and job satisfaction impact the specific facets of quality of care.

Program Evaluation of Medical Team Training Programs in the Department of Defense

For this project, AIR evaluates the effectiveness of Crew Resource Management (CRM) training programs for military medical teams. This project involves: conducting a comprehensive review of military medical team training; comparing and contrasting CRM training in the medical and aviation domains; convening an expert panel of human factors researchers; developing an assessment instrument for measuring the training’s effectiveness; testing the assessment instrument in a variety of domains (e.g., anesthesia, family practice, combat medicine); and developing an Evaluation Toolkit.

Assessment of the National Eye Health Education Partnership (NEHEP)

For this project, AIR evaluated the effectiveness of the National Eye Health Education Partnership and analyzed media coverage of eye health issues. AIR conducted a mail survey of partners in the NEHEP. For the media analysis, AIR collected archival records of media coverage and developed a coding scheme to capture pertinent topics.

Evaluation of the Impact of the Cancer Information Service

This project involved a 10-year retrospective evaluation of the NEHEP of the effectiveness of all three major components of the Cancer Information Service—the telephone service, the research program, and the partnership program.

Indiana State Tobacco Evaluation and Research Coordinating Center (TERCC)

The goal of this project was to provide coordination and implement the evaluation of the Indiana Tobacco Prevention and Cessation (ITPC) Programs. The evaluation included an assessment of the effectiveness of the Indiana comprehensive tobacco control program with respect to the anti-tobacco media campaign to change the social norms and acceptability of tobacco use; and activities of local coalition and Statewide partners to promote grassroots efforts to reduce tobacco use.

Analysis of Medicare Future

AIR conducted analyses of policy issues affecting Medicare’s future, focusing on three major components. First we examined issues concerning Medicare supplementary insurance, particularly Medigap, including the simulation of a high option Medicare designed to replace Medigap, using data from the Medicare Current Beneficiary Survey. A qualitative assessment of how Medicare interacts with the rest of the health care system was also completed. Finally, some resources under the grant were used to track current policy changes and to produce various materials on an as-needed basis. Papers were written on the simulation findings concerning supplemental insurance and on Medicare interactions with the health care system, with briefs or testimony on current issues.