There was a great article on Health Affairs website discussing the failures of nursing home oversight by CMS and their attempts to improve.

“More than 30 years after Congress passed the Nursing Home Reform Act, we are still failing to protect nursing home residents. Recent cases of abuse and neglect, repeated failures of governmental oversight, and stories of owners’ mendacity and greed are not only wake-up calls but sobering reminders of how far we have to go.”

The government has focused attention on nursing home care, releasing blueprints to put “patients over paperwork.” CMS also issued a proposed rule in July taking aim at a range of regulatory provisions it characterized as “unnecessary, obsolete, or excessively burdensome.” Advocacy groups expressed skepticism about CMS’s claims that these changes would “produce significant savings without jeopardizing patient care in any way” and that the “reduction in red tape [will] free up facility resources to focus on patient care.”

Nursing home providers are entrenched in a blind faith in deregulation (if only we reduced regulatory burden, providers could focus resources on resident care). CMS reflects the administration’s broader push toward deregulation and have exacerbated tensions between providers and advocates.

“Most visible among these changes are the repeal of the Obama administration’s arbitration ban, guidance that lessened financial penalties for past non-compliance, and a proposal to relax the frequency of surveys for better-performing facilities.”

“A key aim of nursing home oversight over the past decade has been to ensure greater transparency in nursing homes’ ownership and financing. Nursing homes have been mostly for profit for decades. In the early 2000s, increased private equity investment and ownership complexity spurred a renewed focus on this topic, culminating with provisions to bolster disclosure of ownership and financial relationships being included in the Affordable Care Act. Still, in the wake of scandals such as Skyline Healthcare, where a single owner acquired almost 100 facilities over a relatively short time period across multiple states before running them into the ground financially and putting vulnerable residents at risk in the process, it is clear that substantial gaps still exist.”

CMS should make more complete ownership data widely available, not only to researchers but to state licensure agencies that evaluate applications from potential operators. In addition, CMS should add the ability to examine care across all facilities of specific owners to the Nursing Home Compare website, allowing consumers and others to see quickly if an owner is generally involved in the provision of higher- or lower-quality nursing home care.

Beyond ownership, improving the ability to understand where nursing homes spend their resources and gaining a more accurate sense of their financial well-being are important elements of transparency. Progress has been made in simplifying nursing home cost reporting, yet, according to the Government Accounting Office, there are still substantial questions about the accuracy and completeness of these data. CMS should take further steps to ensure the veracity of these data and develop summary measures for inclusion in public use files or even on the Nursing Home Compare site to convey an accurate picture of facilities’ financial status and spending priorities.

 

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