CMS cracks down on the nation’s poorest-performing nursing homes

Photo by Ulrich Joho via flickr.

The Centers for Medicare & Medicaid Services (CMS) announced it is increasing scrutiny and oversight over the country’s poorest-performing nursing facilities, to immediately improve the care they deliver. A series of revisions to the Special Focus Facility (SFF) Program will toughen requirements for completion of the program and increase enforcement actions for facilities that fail to demonstrate improvement. CMS is also calling on states to consider a facility’s staffing level in determining which facilities enter the SFF Program.

The Oct. 21 announcement is part of a series of new actions aimed at the worst offenders in the nursing home industry, improving the quality and safety of nursing homes, and better holding facilities accountable for improper and unsafe care.

The revised standards present an opportunity for journalists to investigate poorly performing nursing homes in their communities and examine what, if any, action is underway to improve care and quality. We’ve previously reported on how to use payroll-based journal data to analyze staffing issues and highlighted a report from the Government Accountability Office (GAO) about inadequate nursing home staffing, an issue only exacerbated by COVID-19. 

“Let us be clear: we are cracking down on enforcement of our nation’s poorest-performing nursing homes,” said HHS Secretary Xavier Becerra in a statement. “As President Biden directed, we are increasing scrutiny and taking aggressive action to ensure everyone living in nursing homes gets the high-quality care they deserve. We are demanding better because our seniors deserve better.”

Among the revisions to the SFF Program:

  • Tougher SFF program completion requirements: CMS is adding a threshold that prevents a special focus facility from exiting based on the total number of deficiencies cited — no more “graduating” from the program’s enhanced scrutiny without demonstrating systemic improvements in quality.
  • Funding cut for lack of improvement: CMS is considering all facilities cited with Immediate Jeopardy deficiencies on any two surveys while in the SFF Program for discretionary termination from the Medicare and/or Medicaid programs.
  • Tougher enforcement: CMS is imposing more severe, escalating enforcement remedies for SFF Program facilities that have continued noncompliance and little or no demonstrated effort to improve performance.
  • Longer oversight period: CMS is extending the monitoring period and maintaining readiness to impose progressively severe enforcement actions against nursing homes whose performance declines after graduation from the SFF Program. The goal is to promote the sustainability of facilities’ improvements to ensure they do not regress post-program.

In another revision to the SFF Program, CMS is advising State Survey Agencies to consider a facility’s staffing level, in addition to its compliance history, when selecting candidates from their state for inclusion into the SFF Program. It’s well known that poor staffing levels significantly impact the quality of care, according to the Center for Medicare Advocacy.

CMS is encouraging facilities in the SFF program to make good-faith efforts (and provide evidence of these efforts) to improve quality and measurable changes, such as changes in staffing, leadership or increased overall staffing. These efforts will be considered when evaluating potential enforcement actions for noncompliance. For example, SFFs with noncompliance and no evidence of good efforts to improve quality will be subject to more severe enforcement sanctions, such as higher penalties, or suspension or termination of federal funding.

Since its inception, the SFF Program has identified the poorest-performing nursing homes in the country for increased scrutiny to rapidly make and maintain improvements in the quality of care they deliver. These facilities are inspected about twice as often as all other nursing homes — and at least once every six months — and face increasingly severe enforcement actions if improvement is not demonstrated. Facilities must pass two consecutive inspections to complete the program. 

Currently, 88 nursing homes participate in the SFF Program, approximately 0.5% of all nursing homes in the country. CMS assigns each state a specific number of “slots” on the list, which roughly aligns with the number of nursing homes in the state, according to this New York Times story. The SFFs on the lists rotate because there are not enough inspectors to oversee more than a handful of the most problematic facilities at a time.  

“People in this country’s nursing homes deserve access to safe and high-quality care, and facilities that aren’t providing that level of service need to improve their performance or face the consequences,” said CMS Administrator Chiquita Brooks-LaSure. “Poor-performing nursing homes have the opportunity to improve, but if they fail to do so, the changes we are making to CMS’ Special Focus Facilities Program will hold these facilities accountable for the health and safety of their residents.”

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