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Volume 12 Number 221 News: Nursing Homes The Centers for Medicare & Medicaid Services will make public the names of at least 62 poorly performing nursing homes on the agency's Nursing Home Compare Web site by Dec. 1, Acting Administrator Kerry N. Weems told the Senate Special Committee on Aging Nov. 15. According to Committee Chairman Herb Kohl (D-Wis.), the agency's action is "aligned" with the agenda that he and Sen. Chuck Grassley (R-Iowa) are promoting in an upcoming bill focusing on increasing transparency and strengthening enforcement to improve nursing home quality. Additionally, CMS plans to respond to Grassley's July 24 letter requesting that the agency create a public watch list of nursing homes that are repeatedly found to "yo-yo" in and out of compliance and only temporarily fix chronic problems affecting quality of care (No. 143 HCDR 7/26/07 a0b4y0r3a7 The facilities whose names will be posted are those with the worst survey findings in the country and they are part of the agency's Special Focus Facility Program, Weems said. CMS applies "progressive enforcement" through the program until the facility "graduates" because of significant improvements, is terminated from Medicare and Medicaid participation, or is given more time as a result of its potential for improvement, Weems said.
We are "finding that this program really works," he told the committee.
Currently, the agency posts nursing home quality data on its Nursing Home Compare Web site.
CMS's 'Quality Milestones.'
Weems provided to the committee a broad overview of the agency's quality goals for 2008.
For instance, CMS plans to invite states and nursing homes in March 2008 to participate in a value-based purchasing demonstration project to improve incentives for high quality care, he said.
CMS also intends to issue in May 2008 a final report on the findings of a 3-year pilot program involving background checks on new hires at nursing homes, Weems said.
The agency plans to issue a final regulation requiring nursing homes to have sprinkler systems in August 2008, he said.
Grassley asked CMS in an Aug. 22 letter to provide a progress report on the agency's efforts to improve fire safety standards in Medicare- and Medicaid-participating nursing homes, citing a 2004 Government Accountability Office report on deficiencies in nursing home fire safety that prompted a CMS proposed rule in October 2006 requiring that nursing homes without sprinkler systems be retrofitted with them (No. 165 HCDR 8/27/07 a0b5a9x9c1 Additionally, Weems said he envisions the agency will support legislative efforts to permit collection and escrow of civil monetary penalties leveled against noncompliant nursing homes as soon as they are imposed, which he anticipated could be "reasonably enacted by Congress in 2008."
Transparency, Enforcement Bill Forthcoming
Sens. Kohl and Grassley plan to introduce their bill on nursing home quality, transparency, and enforcement in the "coming weeks," according to a statement.
Only some of the bill's specifics were discussed, including a provision overlapping with CMS's action to disclose the names of the worst performing nursing homes.
Additionally, the bill would provide public and timely access to other information on nursing homes, such as results of government inspections, the number of staff employed at the home, and details about the home's ownership, according to a statement.
Kohl also said the bill would strengthen enforcement. "We need the threat of sanctions to mean something--and under my bill with Sen. Grassley, they will," he said.
Although the bill was only broadly sketched by the senators, Grassley testified on issues, such as transparency and enforcement, that Kohl indicated will be its focus.
Incentives for Temporary Corrections
Concerning enforcement, Grassley said the current system "provides incentives to correct problems only temporarily and allows homes to avoid regulatory sanctions." This is "unacceptable," he said. "It's not humanitarian."
To address this issue, he said, Weems's proposal to collect civil monetary penalties sooner, to be held in escrow pending the decision on appeal, is "a good start."
Grassley also addressed fire safety, welcoming CMS's intention to issue a final rule in 2008.
Finally, the senator reiterated his commitment to an inquiry into private equity firms and their ownership of nursing homes that he launched with Sen. Max Baucus (D-Mont.) in October, saying he will "take whatever measures are appropriate in addressing this issue" (see related item in this issue a0b5k0r0a0 The senators asked CMS for a briefing to address the growing trend of nursing home ownership by large investment firms and its effect on quality of care. Grassley and Baucus also sent letters to five private equity investor companies requesting information about nursing homes they own (No. 205 HCDR 10/24/07 a0b5g8g6p6 The Service Employees International Union (SEIU), service workers including some in health care facilities, released a report Nov. 15 showing what it described as a "link" between private equity ownership and problems with nursing home care.
Arvid Muller, assistant director of research with SEIU, who testified before the committee, welcomed the pending legislation, and urged the senators to increase the transparency and accountability of corporate ownership and promote improved staffing.
More information about the hearing.
By Morgan Weiland
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