Providers Ask CMS to Change Proposed Warning Logo on Nursing Home Compare

Less than a week after the federal government proposed a new warning symbol for nursing homes with a history of abuse, a leading trade group has asked for a less severe icon.

The American Health Care Association (AHCA) late last week called on the Centers for Medicare & Medicaid Services (CMS) to ditch its red, stop-sign-style warning logo for something that doesn’t necessarily indicate a complete halt.

“We recommend using a symbol to suggest either ‘caution’ or need to investigate further, as you might see on the roadway or as you do for Special Focus Facilities (SFF) (i.e., a yellow triangle with an exclamation point) would be more appropriate,” AHCA president and CEO Mark Parkinson wrote in a letter to CMS administrator Seema Verma.


Verma and CMS last Monday announced the warning-symbol initiative as a way for residents and their families to clearly and concisely determine if a particular nursing home has a history of abuse or neglect.

“With today’s action, the Trump administration is putting critical information at consumers’ fingertips, empowering them and incentivizing nursing homes to compete on cost and quality,” Verma said in a statement.

The new icon, which will begin appearing October 23, features an open palm on a red circle. Federal regulators will apply the logo to facilities that that had citations related to resident abuse that caused harm within the past year — as well as properties with citations for abuse that could have potentially resulted in harm in either of the preceding two years.


In Parkinson’s view, the symbol goes too far.

“The icon selected creates a strong visual recommendation ‘to stop and avoid’ going to this nursing home,” he wrote. “A red ‘stop sign,’ with a hand on it, is inconsistent with the message outlined in the press release that the information on the site should help ‘consumers develop a more complete understanding of a facility’s quality.'”

The AHCA chief also expressed concerns that the system may not be updated frequently enough, with the logo potentially lingering even after the problems associated with the citations have been corrected; the icon will be removed once providers receive clear surveys, with the system updated monthly, CMS said last week.

“These could have potential unintended effects of creating unnecessary worry and concern among residents and their families and decrease access to care if patients avoid without current significant problems that continue to have an icon suggesting consumers avoid the facility,” Parkinson said.

The warning symbol marked the latest in a string of recent CMS efforts to beef up Nursing Home Compare and its five-star rating system for skilled nursing facilities, coming on the heels of a March initiative that saw stricter achievement thresholds and separate ratings for short- and long-term care quality.

The Nursing Home Compare overhaul in turn forms a pillar of Verma’s overall five-point plan for boosting nursing home oversight and enforcement.

In his letter to Verma, Parkinson emphasized that the organization appreciates CMS’s increased attention on nursing home transparency and abuse prevention efforts; he applied that same welcoming attitude toward the new Medicare payment model at the organization’s annual conference and exposition, which kicked off Monday in Orlando, Fla.

Addressing the recent shift to the Patient-Driven Payment Model — and subsequent concerns over changing therapy patterns, including layoffs and hour reductions for therapists — Parkinson reiterated his organization’s support of a more patient-focused reimbursement model.

“We’ve taken a lot of criticism for providing too much therapy,” he said during his opening remarks. “Thank goodness CMS has recognized that we need to treat the whole patient.”

He also echoed other voices in the space who emphasized the continued need for strong quality outcomes under the new model.

“Don’t judge us by minutes under an old system that we know is flawed,” he said. “Judge us by our outcomes.”

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