Verma: CMS Should Reduce Survey Frequency for Top Nursing Homes, Look Beyond Monetary Penalties

The leader of the Centers for Medicare & Medicaid Services (CMS) on Wednesday continued her public push for greater nursing home oversight, promising that the agency will use data to target states with suspiciously low rates of citations — while also expressing a desire to reduce survey frequencies for top performers.

CMS administrator Seema Verma released the first of five promised deep dives into the agency’s recent efforts to bolster nursing home safety, laying out her vision for strengthened oversight of the nation’s more than 15,000 facilities.

“We at CMS bear the responsibility to develop and enforce quality and safety standards across the nation’s health care system, and we are deeply committed to that job,” she wrote. “Every nursing home resident deserves to be treated with dignity and respect, and all of our nursing home work at CMS is predicated upon that single goal.”


To that end, Verma touted CMS’s moves to create greater consistency among State Survey Agencies (SSAs), the local-level groups that conduct federally mandated inspections of nursing homes each year. CMS has consolidated its databases for SSAs into a single system, with officials probing the data to find any state-to-state inconsistencies.

“As the survey results come in, we’re analyzing the data, including focusing on outliers, such as states reporting a significantly lower than average number of citations per survey,” Verma wrote. “We review SSAs that are outliers and when warranted, require corrective action plans to ensure they are following CMS policies and procedures as expected.”

Those action plans may increasingly take the form of non-monetary penalties, though Verma was mum about the exact nature of the enforcement mechanisms.


“CMS is considering new ways to address SSA performance problems beyond financial penalties — which can sometimes make bad situations worse,” she wrote.

The administrator also reiterated her support for reducing the frequency of surveys for top-rated nursing homes in exchange for tighter oversight of troubled properties, a change that would require Congressional approval.

“We propose to survey top performing facilities every 30 months, with no more than 36 months between surveys of any single facility,” she wrote. “We would reinvest the savings to strengthen our oversight and quality improvement efforts for facilities that are low performers.”

The federal government has been on a nursing home regulatory tear throughout 2019, prompted in part by Congressional hearings into abuse and neglect, an expose on operators overstating their actual staffing levels, and the lingering response to multiple deaths in the wake of Hurricane Irma back in 2017.

CMS in March announced a major overhaul to the consumer-facing five-star rating system for nursing homes, splitting the ranking into separate measures for short- and long-term stays while also cracking down on staffing ratings. A few months later, the agency agreed to begin releasing a previously undisclosed list of skilled nursing facilities considered for inclusion in the Special Focus Facility program — after a bipartisan pair of U.S. senators made the information public in a press release.

Verma has been particularly vocal in promoting her five-point plan for nursing home improvement — hence the five deep dives on CMS’s blog — and recently took to the agency’s podcast to elaborate on the initiatives.

“This issue is a very important one,” Verma said on the episode, released at the end of July. “The president takes it very seriously.”

Specifically, Verma cited the inclusion of about $45 million in extra funding for state survey agencies in President Trump’s fiscal 2020 budget proposal, a boost that the American Health Care Association commended.

“AHCA supports the request for more funding to strengthen the survey process and to support State Survey Agencies and their work,” David Gifford, the organization’s senior vice president of regulatory and government affairs, said in a statement provided to SNN. “The consistency and timeliness of the survey process is important, and we support CMS’s work to address those issues.”

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