Representatives from the federal agencies that oversee skilled nursing agencies faced pointed questions from lawmakers on Capitol Hill on Thursday morning, with many expressing frustration with recurring resident safety issues.
“We do this over and over again, but yet one-third of Medicare residents have experienced harm,” Rep. Diana DeGette, a Colorado Democrat, said during a hearing held by the House Committee on Energy and Commerce.
DeGette was referring to a February 2014 report from the Department of Health and Human Services (HHS) Office of the Inspector General (OIG), which found that 33% of all Medicare beneficiaries experienced either adverse events or temporary harm while staying in nursing homes between 2008 and 2012. She and others also pointed out that concerns over patient harm in skilled nursing facilities has remained a top enforcement priority for the OIG for many years, though cases continue to be reported nationwide.
Witness Ruth Ann Dorrill, regional inspector general for the OIG, testified that those problems don’t always represent major, catastrophic incidents such as the deaths at the Rehabilitation Center at Hollywood Hills in Florida last year — which several of the representatives mentioned when expressing concerns about resident safety.
“When you speak with the people who have chosen to spend their professional lives in these settings, they will tell you nursing home care is incremental — and by that I mean the gains and the losses can be small, and around the margins,” Dorrill said. “Nursing homes can be places of caring and healing. They can make the difference between someone having 10 more good years or a downward spiral. But it’s important to recognize that people who enter nursing homes are at low points, are at times of crisis.”
The Hollywood Hills case loomed large over the hearing, with multiple representatives expressing outrage that facility owner Jack Michel was allowed to continue operating facilities despite paying fines relating to Medicare and Medicaid fraud.
But Centers for Medicare & Medicaid Services (CMS) chief medical officer Dr. Kate Goodrich asserted that under current rules, the federal government’s hands are tied.
“There’s nothing in Medicare that prevents Dr. Michel from having ownership interest in Medicare facilities. Medicare can only bar an individual that has been convicted of a felony or who is on the OIG exclusion list,” she said.
Still, Dorrill and Goodrich emphasized that the government has taken great strides in recent years to beef up safety standards in nursing homes, including the new Requirements of Participation (RoPs) which continue to be rolled out through 2019. But Dorrill said the entities that oversee the long-term care industry have work ahead to coordinate their efforts and follow through on enforcing the new rules.
“All progress will lie in the execution on the part of CMS, on the part of the state agencies, on the part of the nursing home,” Dorrill said.
The hearing came in the same week that the leaders of another House committee issued a call for CMS to ease red tape for nursing homes, specifically singling out billing issues that both providers and accountants have described as problematic.
“This is a testament to the fact that there is a real opportunity to get red tape out of the way in order to drive more efficiency and promote innovation, while reducing costs and improving patient care,” Reps. Kevin Brady and Peter Roskam of the Ways and Committee wrote in a letter to administrator Seema Verma.
During the hearing, Goodrich faced questions over CMS’s decision to delay enforcement actions against skilled nursing facilities under the second round of RoPs, implemented last year.
“The agency is restraining itself from using some of its most effective enforcement tools against those who violate these new rules designed to protect vulnerable nursing home residents,” DeGette said.
Goodrich responded by emphasizing that CMS remains on track to roll out the third phase by the fall of 2019.
“We are taking a thoughtful approach to implementation and providing education to providers while holding them accountable for any deficiencies,” she said.
On the other end of the spectrum, Rep. Greg Walden — an Oregon Republican — questioned whether the federal government could reach too far when attempting to prevent disasters such as the one in Hollywood, Fla. Walden spoke of his own experience watching his mother’s nursing home caregivers spend significant periods of time filling out paperwork.
“Sometimes government just overreacts and says we need a new rule, we need a new regulation — which, in the end, eats up a resource that’s hard to get,” Walden said, referencing the widespread caregiver shortage across the health care spectrum. “… Would my mother have been better off with less reporting and paperwork and somebody who was checking on her more often? And we’ve got to have both.”
Rep. Buddy Carter, Republican of Georgia and a pharmacy owner, echoed that sentiment while also imploring CMS to bring “bad actors” to justice.
“I just want to make sure that we’ve got balance here. I want you to understand that I’ve worked side-by-side with these people in the nursing homes,” Carter said.
Written by Alex Spanko