House Committee Holds Hearing on Nursing Home Quality Issues

For the first time in many years, Congress held a hearing on nursing home quality of care on September 6, 2018.  The hearing of the Subcommittee on Oversight and Investigations of the House Energy and Commerce Committee, entitled “Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes,” featured three witnesses: Kate Goodrich, Director, Center for Clinical Standards and Quality, and Chief Medical Officer, Centers for Medicare & Medicaid Services (CMS), Ruth Ann Dorrill, Regional Inspector General, HHS Office of Inspector General (OIG), and John Dicken, Director, Health Care, Government Accountability Office (GAO).[1] 
Dr. Goodrich summarized CMS’s actions with respect to emergency preparedness, the Five-Star Quality Rating System, the Payroll-Based Journal system for reporting nurse staffing, and the new federal survey process.  The OIG and GAO witnesses recounted highlights of their many nursing home reports over the last several years.  Ms. Dorrill reported “widespread, serious problems in nursing homes” and the “low-level substandard of care [that] harms a tremendous number of people.”  As Chairman Gregg Harper (R, MS) underscored, the OIG has identified nursing home quality as a top management challenge for CMS for the past decade.  Over the past two decades, the GAO issued more than two dozen reports finding shortcomings in nursing home care and in state and federal oversight.
Many Members of Congress focused on Hollywood Hills, the Florida nursing facility where 14 residents died in 2017 when Hurricane Irma resulted in the facility’s losing its air conditioning.  One question, raised by several Members, was how the owner of that now-terminated nursing facility, who had also been subject to a Corporate Integrity Agreement years earlier, could still continue to own 11 different facilities that receive Medicare and Medicaid reimbursement.  Dr. Goodrich indicated that nothing in the Medicare law prevents the owner from continuing to own other facilities, but that a proposed rule from 2016 could enhance CMS’s authority.[2]
Congresswoman Jan Schakowsky (D, IL) raised concerns about the ongoing misuse of antipsychotic drugs, inadequate nurse staffing levels, and the lack of a requirement for registered nurses around the clock, while Congresswoman Mimi Walters (R, CA) focused on transfer and discharge issues.
The American Health Care Association (AHCA), the nursing home trade association, issued a statement describing the progress the industry has made in reducing hospitalizations and the use of antipsychotic drugs and improvements in 20 of 24 quality measures and staffing levels.[3]   AHCA’s CEO Mark Parkinson said that although nursing homes’ progress should be acknowledged, “The reality is that nursing homes are a convenient political punching bag.”   He continued, “At a time when Congress faces public criticism for its failure to work together and accomplish shared goals, this hearing seems like a misguided effort to find more ways to regulate an already overburdened sector.”
The Center for Medicare Advocacy prepared a Statement for the record describing the lack of meaningful enforcement of federal standards of care; “the virtually non-existent oversight, at both the federal and state levels, of who owns and manages nursing facilities;” the ongoing gaming by facilities in the quality measures domain of the Five-Star Quality Rating System; and the need for improved nurse staffing levels.[4]
It is not yet known what the Subcommittee’s next steps will be.

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[1] The witnesses’ written statements, opening statements of the full Committee and Subcommittee Chairs, and Background Memo are available at https://energycommerce.house.gov/hearings/examining-federal-efforts-to-ensure-quality-of-care-and-resident-safety-in-nursing-homes/.
[2] Dr. Goodrich appears to have been referring to a proposed rule required by the Affordable Care Act, “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process,” CMS-6058-P, 81 Fed. Reg. 10720 (Mar. 1, 2016), https://www.gpo.gov/fdsys/pkg/FR-2016-03-01/pdf/2016-04312.pdf.  It is unlikely that the proposed rule will be published as a final rule.
[3] “AHCA Statement on Congressional Hearing,” https://www.ahcancal.org/News/news_releases/Pages/AHCA-Statement-on-Congressional-Hearing-.aspx.
[4] http://www.medicareadvocacy.org/wp-content/uploads/2018/09/Centers-Statement-on-Nursing-Home-Hearing.pdf.