Monday, March 26, 2018

The Next Phase of the AHCA/NCAL Quality Initiative


On March 13, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) announced new goals as part of its nationwide, multi-year initiative to further improve quality in long term and post-acute care centers and communities. Building on the progress of the profession over the last six years, the Quality Initiative will challenge member providers to achieve measurable targets in key areas by March 2021.

The three-year goals for skilled nursing centers are aligned with top priorities for the Centers for Medicare & Medicaid Services (CMS) and federal mandates that link financial outcomes to quality performance. They are:

  • Safely reduce long-stay and short-stay hospitalizations by improving 10 percent—or maintain a rate of 10 percent or less;
  • Improve functional outcomes (self-care and mobility) by 15 percent;
  • Improve long-stay and short-stay satisfaction by 10 percent—or achieve a rate of 90 percent or greater; and
  • Safely reduce the off-label use of antipsychotics by 10 percent—or maintain a rate of 8 percent or less in long-stay residents, and maintain a rate of 1 percent or less in short-stay residents.


The three-year goals for assisted living communities are:

  • Reduce turnover among direct care staff¬ to a rate of 50 percent or less;
  • At least 90 percent of customers (residents and/or families) are satisfied with their experience;
  • Safely reduce hospital readmissions within 30 days of hospital discharges to a rate of 20 percent or less; and
  • Safely reduce the off¬-label use of antipsychotics to a rate of 15 percent or less.


Since the launch of the Quality Initiative in 2012, skilled nursing members have achieved reductions in the use of antipsychotics and in re-hospitalizations. Specifically, over half (57 percent) of skilled nursing member organizations safely reduced the off-label use of antipsychotic medications by 30 percent in the third quarter of 2017. For hospital readmissions, skilled nursing members have safely prevented more than 142,000 individuals from returning to the hospital — a 12 percent reduction since 2011.

The Quality Initiative is also inspiring the state-based, assisted living profession to collect and report national quality data without a government mandate. While overall progress is not yet viable to report, the number of assisted living communities self-reporting to AHCA/NCAL is growing.

To monitor progress among skilled nursing centers nationwide, AHCA will use CMS measures to track progress on antipsychotic usage, and measures endorsed by the independent rating organization National Quality Forum (NQF) to track progress on re-hospitalizations, functional outcomes and customer satisfaction. The assisted living goals will use measures developed by AHCA/NCAL.

To help achieve the goals, AHCA/NCAL encourages members to access free resources on ahcancalED at educate.ahcancal.org

Members are also encouraged to view and track their progress using AHCA/NCAL’s LTC Trend Tracker, a web-based, data collection and benchmarking tool. Not sure if your organization uses LTC Trend Tracker? Email help@ltctrendtracker.com and request the name of your account administrator.  

To learn more about the AHCA/NCAL Quality Initiative, visit qualityinitiative.ahcancal.org (SNFs) or qualityinitiative.ncal.org (ALs).

And be sure to join AHCA/NCAL for a deeper dive with two free webinars for skilled nursing and assisted living members, respectively:

  • Assisted Living: “The NCAL Quality Initiative 2018-2021” on Tuesday, April 10 from 3:30 p.m. to 4:30 p.m. Eastern. Register here.


  • Skilled Nursing: “The Quality Initiative 2018-2021: What’s New & What it Means for You” on Thursday, April 12 from 3 p.m. to 4 p.m. Eastern. Register here


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