Leaders at the Centers for Medicare & Medicaid Services (CMS) continued their public push to improve nursing home safety and enforcement this week, laying out plans to mine data to root out bad actors — while also emphasizing that the initiative goes all the way to the top of the federal government.
“This issue is a very important one,” CMS administrator Seema Verma said on the most recent episode of the agency’s podcast series, released Wednesday. “The president takes it very seriously.”
Verma and CMS chief medical officer Kate Goodrich used the platform to expand on the agency’s newfound push to overhaul the regulation and punishment of skilled nursing facilities, initially launched in April in the wake of a harrowing Senate hearing that featured testimony from family members of those who had been abused and neglected in nursing homes.
The initiative focuses on five key areas of improvement: oversight, enforcement, transparency, quality, and reducing paperwork burdens for operators. Verma has laid out these points in several other settings since April, and CMS has taken a variety of steps to achieve those goals — including ordering the regular release of properties considered candidates for the Special Focus Facility program, and delaying enforcement of the final round of new Requirements of Participation with an eye toward preventing bureaucratic headaches for operators.
But Wednesday’s podcast episode offered a peek into some of CMS’s future plans, including a more data-heavy approach to identifying specific nursing homes and employees with a history of abuse and neglect.
“We have a treasure trove of data here at CMS,” Goodrich said. “We are mining those data to note large patterns and identify workers within nursing homes with a previous history of abuse.”
And that initiative isn’t just internal: Goodrich said CMS will update its consumer-focused Nursing Home Compare website to include even more information about potential problems at individual facilities.
“We want to make it easier for anybody who is looking for a nursing home to see specific issues of noncompliance related to abuse or neglect,” she said. “That needs to be very easy for people to find.”
Improving Nursing Home Compare has been another major area of focus for CMS so far in 2019. Back in March, before Verma formally introduced the five-point plan, officials unveiled new discrete star ratings for short- and long-term care, while also implementing stricter standards for staffing ratings. The latter change came on the heels of a 2018 investigative report showing that operators had routinely inflated their staffing coverage levels, which also prompted CMS to hand out thousands of one-star ratings and impose stricter standards on state-level survey agencies around staffing deficiencies.
Verma expanded on her desire to improve collaboration with those state-level agencies, which are generally responsible for annual nursing home inspections. CMS intends to collect all survey data in a single database, Verma said, with more consistent standards and timelines for individual state agencies to follow in the event of abuse, neglect, or substandard care.
“That way, we have the ability to examine the data for outliers and determine when we may need to follow up with the state,” Verma said. “If we see a particular state having citations in a particular area that seem out of the norm from other regions, then that gives us the ability to analyze that data and to follow up with them.”
That said, Verma and Goodrich repeatedly emphasized that they do not want new regulations to become overly burdensome, or force providers to increase compliance efforts at the expense of resident care. For instance, CMS has asked Congress — through President Trump’s budget proposal — to adjust the frequency of mandatory nursing home inspections, with the eventual goal of requiring fewer for good facilities and more for troubled properties.
“We want to have a little bit more flexibility. There could be providers that are doing a really good job, and we’re not getting complaint surveys,” Verma said. “It’s possible that those don’t need to be done as frequently, and maybe directing our resources to those facilities where we are getting a lot of complaints.”
In the end, Verma said, any new regulations should be focused squarely on the resident.
“We’ve talked a lot about the operational changes that we’re making, the policy changes that we’re making, but at the end of the day, this is about putting patients first,” she said. “It’s about ensuring that every person that goes to a nursing home can expect a high level of safety and quality.”