By Alex Spanko | April 15, 2019
The leader of the
Centers for Medicare & Medicaid Services (CMS) on Monday announced a
“comprehensive review” of safety and quality standards for nursing homes, while
also touting the progress made in recent years.
“CMS is not waiting,
and not settling for the status quo: I have directed my team at CMS to
undertake a comprehensive review of our regulations, guidelines, internal
structure, and processes related to safety and quality in nursing homes,” CMS
administrator Seema Verma wrote in a blog post released Monday. “America
deserves nursing homes that ensure residents are treated with dignity and kept
safe from abuse and neglect.”
Much of Verma’s post
outlined oversight changes already made under her watch and the previous
administration, including moves to implement stricter staffing requirements,
reduce unnecessary use of anti-psychotic drugs, and more closely align
reimbursements with performance — specifically pointing to the Skilled Nursing
Facility Value-Based Purchasing (SNF VBP) program, under which operators receive penalties for failing
to improve certain quality metrics.
But Verma also used
her platform to highlight a variety of potential initiatives that CMS may adopt
in the near future, repeatedly emphasizing that the federal government isn’t
done overhauling its regulations for the nation’s more than 15,000 nursing
homes.
For instance, Verma
discussed CMS’s efforts to standardize its interactions with state survey
agencies (SSAs), which have historically applied federal rules differently
depending on location. Moving forward, CMS plans to establish “clear timelines”
under which SSAs must report alleged abuse and neglect, and it has already
streamlined its state-level guidance for determinations of “immediate jeopardy”
violations.
The news came on the
same day that the U.S. Government Accountability Office (GAO) released a report
calling on CMS to bolster its oversight of SSAs after finding a 15-year gap in abuse
investigations and reporting in Oregon nursing homes.
High-tech solutions
Verma floated the idea
of more effectively rooting out nursing home staffers with histories of
resident abuse, while also employing technology to more accurately track
operator and patient outcomes.
“We’re exploring the
possible use of Medicare claims data and associated adverse outcomes or
indicators, including the use of artificial intelligence and text mining, to
inform our nursing home survey and oversight process, especially for
individuals transferred from a nursing home to a hospital,” Verma wrote.
CMS has also requested
$442 million for survey and certification efforts in the president’s budget
request to Congress, Verma noted — though the House and Senate are under no
obligation to approve the White House’s plan as is. The Trump budget blueprint
would also change the frequency of nursing home surveys so CMS can “continue to
meet the statutory survey requirement while dealing with the increase in volume
and severity of complaints, and rising survey costs,” according to Verma.
In addition, CMS is
considering new ways to incorporate data about abuse improper anti-psychotic
use into its consumer-facing Nursing Home Compare site; the agency
already rolled out new separate star ratings for
short-term and long-term care services this year. CMS has also moved to
increase transparency around its assessment of nursing homes, posting notice of
every agreement termination with deficient nursing homes on its website —
instead of only in local newspapers — and working to make official health and
safety deficiency reports easier to understand for the average consumers.
“Because these reports
can be difficult for the public to understand, we’re working on ways to make
them more accessible,” Verma wrote. “We want them to be clear so the public has
full knowledge of the scope and severity of any problems identified during our
nursing home inspections.”
Provider burdens in mind
Though Verma’s post
had overall tough language regarding deficient nursing homes, she also
reiterated her agency’s commitment to reducing paperwork and mitigating
administrative burdens when developing new guidance and regulations for SNFs.
“High administrative
costs can make it difficult for facilities to operate. In rural America, a
shuttered nursing home can present serious access to care problems,” she wrote.
“We are developing our regulatory strategy in a way that puts patient quality
and safety first while removing unnecessary burdens on providers that create
staffing challenges and increase cost without increasing quality.”
Verma’s post comes at
a time of increased national coverage of nursing home safety issues, with a
March hearing hosted by Sens. Chuck Grassley and Ron Wyden highlighting
particularly gruesome examples of resident abuse in institutional long-term
care settings.
“This is a systemic
problem that does not seem to respond to whoever’s in control of any
bureaucracy here,” Grassley, an Iowa Republican said during the hearing.
Individual operators
across the country have also increasingly struggled to maintain quality care
amid crippling Medicaid funding shortages, which have brought waves of
closures, bankruptcies, and receiverships to facilities in states across the
country.
Verma’s post concluded
with a strongly worded warning to operators and the industry at large.
“This is not business
as usual — we are pushing beyond the status quo,” she wrote. “We are focused on
ensuring America’s nursing homes are keeping residents safe by rewarding
quality and value, making outcomes transparent, and reducing unnecessary paperwork
that detracts from patient care, and we will not hesitate to use every tool at
our disposal to complete our mission.”
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