WFAA’s News 8 Investigates Omits Key Facts

June 29, 2018

Conctact: Jim Suydam, 512-417-5382


Statement from Kevin Warren, President and CEO of the Texas Health Care Association, regarding WFAA Investigates coverage of QIPP and Dallas County nursing homes

WFAA’s News 8 Investigates Omits Key Facts

“Texas nursing homes receiving supplemental Medicaid funding through the state’s Quality Incentive Payment Program (QIPP) have improved across all four key metrics measured by the program.

That important fact seems to have been missed — or omitted — in WFAA News 8 Investigates’ recent story regarding little improvement in Dallas area nursing homes.

Contrary to what the story suggests, the investment of additional federal money into long term care through the QIPP program has demonstrated improvements in the lives of frail and elderly Texans.

We can see this clearly by looking at the four quality metrics the QIPP payments are incentivized to improve: falls, pressure ulcers, residents on antipsychotic medications and residents requiring physical restraints.

In just the first six months of QIPP, nursing homes participating realized improvements across all four of those key quality measures. Overall, nursing homes receiving QIPP-enhanced reimbursements are now performing better than established benchmark national averages in all four measures.

  • By the end of the second quarter, the average Texas QIPP participant metric score had a 33 percent relative improvement from the program’s baseline.
  • The number of high-risk, long stay residents with pressure ulcers dropped 12 percent.
  • Residents on antipsychotic medication declined by 25 percent.
  • Residents suffering major injuries from falls decreased by 12 percent

A full 80 percent of nursing homes participating in QIPP met the state’s goal of improving by 10 percent from their baseline, or by having a quality measure score better than the national average benchmark.

None of these facts, generated from state data available to the reporters, were included in their story on QIPP.

Instead of reporting on the improvements made in the four QIPP quality metrics, the story reported on a supposed relationship between the QIPP program and the federal 5-Star ratings calculations, whose basic formulations were just changed in 2017, most notably in inspection results and staffing calculations.

That comparison is either disingenuous or uninformed.
The federal five star rating system draws from a variety of data sources including state health inspections of facilities, CMS’ Payroll-Based Journal System, the federal Minimum Data Set national data base, and Medicare claims data.

QIPP’s improvements and payments are based upon four publicly reported measures. These four measures are a part of 16 5-star quality metrics, which are included in the over 20 data points used to calculate the federal five-star rating system.

Even if a facility experiences improvement in the metrics the are linked to QIPP, it may not show improvement in its star rating unless there is a preponderance of improvement in the areas on which the star ratings are based.

Of note, in April 2018, the Centers for Medicare and Medicaid Services (CMS) revised how it determines the staffing composite score. As a result, several facilities experienced a drop in their star rating despite providing the same level of care prior to the change. In addition, because of the new inspection process implemented by CMS in November 2017, the findings from the new inspections won’t be used to calculate each nursing home’s star rating. According to the CMS website, “ratings will be calculated using results from surveys that occurred before November 28, 2017. Therefore, the ratings may not reflect the most recent assessment of compliance and quality that exists in a given facility.

These changes in the 5-star calculations result in fundamentally different calculations than the old measures and comparisons between the two are not meaningful.

It is important that the efforts to improve the quality of long term care in Texas continue to expand and it is recognized there is still much work to be done and I appreciate WFAA’s recent interest in seeing continued improvement. I hope, however, they will see that there is a bigger story here: Texas nursing homes are chronically underfunded by one of the lowest reimbursement rates in the nation.

While there are successes associated with QIPP, it falls well short of addressing the challenges that Texas nursing homes face due to the program’s limited funding and limits on participation.”

About THCA
Founded in 1950, the Texas Health Care Association (THCA) is the largest long term care association in Texas. THCA’s membership is comprised of several hundred licensed nonprofit and for-profit skilled nursing facilities (SNFs), specialized rehabilitation facilities and assisted living facilities in Texas. These facilities provide comprehensive, around-the-clock nursing care for chronically ill or short-term residents of all ages, along with rehabilitative and specialized medical programs. THCA also represents more than 190 long term care businesses that provide products and services to the state’s approximately 2,850 nursing homes and assisted living facilities. To learn more, visit or connect with THCA on Facebook, Twitter and YouTube.