After reviewing a September draft of the IG report, Medicare officials became interested in using the IG’s investigative techniques, methods not normally used in measuring nursing home quality, Dorrill said. For example, the IG and CMS are working to condense the report’s list of 261 instances of actual harm so that nursing home operators and government inspectors could quickly identify health problems noted in a medical record as something that occurred because of poor treatment rather than the natural progression of disease in an elderly patient, she added. The initial list of 261 instances was compiled by a team of expert physicians, geriatricians and nurse consultants who scoured the selected records to make these determinations on a case-by-case basis.
Another strategy CMS plans to use, Dorrill said, is the "trigger tool" IG experts developed to identify instances of potential harm. This tool is a list of 49 medical problems that are warning signs, such as when a resident has to go to the hospital or if a resident's blood glucose level drops dangerously low.