|
Volume 12 Number 85 News: Nursing Homes A "small but significant share" of nursing homes have quality of care problems requiring enhanced enforcement and oversight by the Centers for Medicare & Medicaid Services, a Government Accountability Office official told a Senate panel May 2. In testimony before the Senate Special Committee on Aging, Kathryn G. Allen, director of health care at GAO, outlined GAO's recommendations to CMS from its March report, Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents. The Senate panel's hearing marked the 20-year anniversary of the Nursing Home Reform Act, which established standards for beneficiary care and rights in certified nursing facilities. Committee Chairman Herb Kohl (D-Wis.) said, "We will follow this hearing with a written request to CMS to brief us every two months on progress made to implement the recommendations in GAO's testimony [that have come out] of this hearing." Significant Deficiencies Persist Allen explained that, while the rate of 1 in 5 nursing homes with quality care problems has fluctuated over the past seven years, the data is not completely reliable because GAO has found "significant variation" in deficiency citations across states, indicative of inconsistencies in assessing quality of care, and "understatement" of deficiencies, which she defined as occurring when "deficiencies are found on federal comparative surveys but not cited on corresponding state surveys." CMS enforcement, while strengthened, requires further work, she explained. Specifically, the immediate sanctions policy is problematic because it "appears to have induced only temporary compliance," according to Allen's written testimony. Because the immediate sanctions policy is complex, some nursing homes with the most egregious compliance records are able to avoid sanctions. For example, "a new serious deficiency will not trigger an immediate sanction unless the prior serious deficiency has been corrected," according to the GAO report. Additionally, the term immediate sanctions policy is "misleading" because it requires only immediate notification of CMS's intent to bring sanctions, not immediate implementation of sanctions, she explained. Also problematic is that when a sanction, such as a denial of payment for new admissions, is enacted, there is a gap between the citation and effective date of the sanction, Allen said. Further, when civil money penalties (CMPs) are leveled against a facility and are appealed by the facility, they do not have to be paid until the appeal is resolved. Allen also cited problems with CMS's new data system, which does not have integrated components or complete national reporting capabilities, "hampering the agency's ability to track and monitor enforcement." Concerning CMS oversight, she explained that while it has improved since 1987, competition for resources hinders some programs. For example, implementing a new survey methodology, the Quality Indicator Survey (QIS), has been in the works for "over eight years," she said. In line with several of the GAO report recommendations, Allen explained to Kohl during questioning that a requirement for facilities to pay CMPs up-front would serve as a deterrent. She also said that to sanction facilities that are out of compliance on a continual basis, other strategies such as installing temporary managers or, if the facility is part of a chain, holding the chain accountable would potentially be more effective than current sanctions. The GAO report also recommended that CMS improve the immediate sanctions policy and improve the efficacy of data systems used for enforcement. James R. Farris, Dallas regional administrator for CMS, who also testified before the committee May 2, largely agreed with Allen's recommendations, although he said that precautions should be taken not to "penalize residents" of nursing homes when changes in sanctions are considered. Nationwide Background Checks The committee also heard testimony on Michigan's background check program, and Kohl said he plans "to introduce legislation that is modeled on Michigan's background check program" for workers in long-term care facilities. "This committee has a long history of closely scrutinizing the quality of nursing home care and we intend to reaffirm that commitment," Kohl said. Orlene Christie, director of the Legislative and Statutory Compliance Office for the Michigan Department of Community Health, who oversees Michigan's Workforce Background Check Program, told the panel that since April 1, 2006, the program has screened 98,625 applicants and denied employment to 3,262 people who appeared on lists such as the sex offender registry and the FBI list. "We want to make sure that the nursing home work force is the best it can be by establishing a nationwide system of background checks for workers in long-term care facilities," Kohl said. "I believe that it is time to expand it nationwide." GAO's report is available. Committee member statements and witness testimony are available.
|
