CMS Hints at ‘Calling Out’ Nursing Homes Over Quality Problems

A Centers for Medicare & Medicaid Services (CMS) official last week suggested that the public would benefit from more information about resident safety at nursing homes — including the explicit identification of bad actors.

Writing in response to a November study about the correlation between Nursing Home Compare star ratings and safety, CMS chief medical officer Kate Goodrich laid out a case for strengthening existing data sources for consumers in a letter to the journal Health Affairs.

“While we view patient safety and quality improvement as a continuum, we agree that specifically ‘calling out’ facility performance on patient safety can resonate with and be beneficial to consumers,” Goodrich wrote. “In fact, CMS highlights performance on safety measures as a discrete domain in programs for other types of facilities, including those for hospitals and dialysis facilities.”


The original study, from a team of researchers led by Daniel Brauner of the University of Chicago’s Department of Medicine, found that there were no substantial patient safety differences between buildings in the middle of the five-star range; for instance, while one-star homes had serious quality issues and five-star homes had the fewest, there wasn’t much of an improvement from a two-star to a four-star property.

“Part of the problem with looking at quality measures is, if you dig deeper, they’re very superficial in terms of: It’s either a yes or no,” Brauner told SNN in November, referring to the health inspections and other metrics that go into the development of the CMS rating. “They have it, or they don’t have it. It’s usually much more complicated.”

Goodrich agreed with a significant chunk of the team’s findings, praising the researchers for requesting stronger quality-tracking data and acknowledging that many of the common metrics were designed for hospitals and not SNFs. But she also defended the status quo, and hinted at more changes to come in the future.


“We do believe that NHC contains additional measures that either directly capture harm or are highly correlated with harm that were not evaluated by the authors — such as the measure for inappropriate use of antipsychotics, which is strongly linked to falls and other adverse events,” she wrote. “Nonetheless, we agree that NHC captures only a subset of harm, and a broader set of harm measures may be beneficial.”

For instance, the CMO pointed to recent updates to the Requirements of Participation (RoPs) that required nursing homes to develop Quality Assessment and Performance Improvement (QAPI) plans, as well as more stringent health inspection regulations. In addition, a new metric may soon be coming to the star-rating calculation.

“To that end, CMS is considering the development of a composite measure of health care acquired infections that could be incorporated into NHC star ratings, and will continue to explore additional facets of and measures associated with safety in nursing homes going forward,” she wrote.

Goodrich acknowledged the potential for operator headaches, and emphasized a desire to work with providers and state regulators to strike a balance.

“All of these regulatory and sub-regulatory levers come with some degree of administrative burden, which must be minimized while ensuring that CMS is holding nursing homes accountable for important patient health outcomes, including harm reduction,” she wrote.

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