Underperforming nursing homes named by CMS
Agency hopes exposure will push them to improve
Sometimes the bright light of unwanted attention can spur improvement, and that's the theory behind the Centers for Medicare & Medicaid Services' (CMS) decision to publish the names of underperforming nursing homes.
CMS in November 2007 began publishing the names of "special focus facility" (SFF) nursing homes that had failed to improve significantly after being given the opportunity to do so. (The updated list is available at www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf.)
Once a facility is selected as an SFF, state survey agencies are responsible for conducting twice the number of standard surveys and will apply progressive enforcement until the nursing home:
- significantly improves and is no longer identified as an SFF;
- is granted additional time due to promising developments; or
- is terminated from Medicare and/or Medicaid.
"This is the latest in a series of steps we will be taking to improve quality and oversight in nursing homes," according to Kerry Weems, CMS acting administrator. "We are issuing more information on special focus facilities to better equip beneficiaries, their families, and caregivers to make informed decisions and stimulate robust improvements in nursing homes having not improved their quality of care."
Between November 2007 and February 2008, CMS worked with states to create an SFF list that the agency says is current and provides consumers with the information needed to make a distinction between nursing homes that are improving and those that are not.
The updated and expanded list identifies facilities by the category they fall within:
- New Additions: Nursing homes added within approximately the past six months;
- Not Improved: Nursing homes that have failed to improve significantly in at least one survey after being named as a SFF nursing home;
- Improving: Nursing homes that have significantly improved on the most recent survey, including no findings of harm to any resident and no systemic potential for harm;
- Recently Graduated: Nursing homes that have sustained significant improvement for about 12 months, indicating an upward trend in quality improvement compared to the nursing home's prior history of care; and those
- No Longer in Medicare and Medicaid: Nursing homes that were either terminated by CMS from participation in Medicare within the past few months or voluntarily chose not to continue participation.
Initiative not new, but publicity is
The SFF initiative was created by CMS in 1998 in response to the number of facilities that were consistently providing poor quality of care. Those facilities were periodically instituting enough improvement so that they would pass one survey, only to fail the next, often for the same problems as before.
CMS investigators found that facilities with this compliance history rarely addressed the underlying systemic problems that were leading to the repeated cycles of serious deficiencies deficiencies such as failing to give residents their medications in the correct dose at the correct time, failing to take steps to prevent abuse or neglect, inappropriate use of restraints, and failure to prevent or properly treat bed sores.
Nearly 3 million Americans, most of whom are enrolled in Medicare or Medicaid, are in the 16,000 nursing homes in the United States at some point during each year. The nursing homes listed for each state had survey results that were, at the time of their selection as an SFF, among the poorest 5% to 10% in their state.
The attention is working, CMS reports. Data indicate that about 50% of the nursing homes identified as SFFs significantly improve their quality of care within 24–30 months, while about 16% are terminated from Medicare and Medicaid.
Weems says that by summer 2008, nursing homes that have been designated as SFFs will be able to access technical assistance from CMS to help move into compliance with federal quality of care regulations.
More information on the SFF initiative is available by going to www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp and scrolling down to "Special Focus Facility Background Info and List."
Sometimes the bright light of unwanted attention can spur improvement, and that's the theory behind the Centers for Medicare & Medicaid Services' (CMS) decision to publish the names of underperforming nursing homes.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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