Verma: New Abuse Warning Icon ‘Isn’t Really Going to Impact Very Many Nursing Homes’

Despite widespread anger in the skilled nursing industry, a controversial new warning icon for facilities with previous reports of abuse and neglect will affect only a relatively small proportion of properties, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma told lawmakers in Washington on Wednesday.

Testifying before the House Committee on Energy & Commerce, Verma said the symbols will only appear on “maybe 5%” of the more than 15,000 properties listed on Nursing Home Compare.

“This isn’t really going to impact very many nursing homes,” Verma said. “There are many nursing homes that provide high-quality care, but there are some out there [that don’t], and we think it’s important to make sure that the American people have the information that they need to make the decisions that work best for them.”


CMS rolled out the new warning icon earlier this month, and the symbols — featuring a red circle with an open palm — began appearing on the consumer-facing Nursing Home Compare site Wednesday.

The federal government will apply the warning to facilities that have received citations for abuse that directly led to resident harm over the previous year, as well as abuse citations that could have led to resident harm in each of the preceding two years. Officials will update the icons monthly, removing them for properties that have resolved the associated abuse and neglect issues.

“This means consumers will not be forced to wait for CMS’s quarterly updates to see the latest-related information — and nursing homes will not be flagged for longer than necessary if their most recent inspections indicate they have remedied the issues that caused the citations for abuse or potential for abuse and no longer meet the criteria for the icon,” the agency noted in a statement announcing the program.


Verma’s Wednesday comments came in response to questioning from Rep. Jeff Duncan, a South Carolina Republican, who expressed concerns about uneven application of civil monetary penalties (CMPs) and abuse citations, particularly in his home region.

“I understand this initiative goes into effect today,” Duncan said of the abuse-icon plan. “However, I feel CMS needs to fully solve the CMP and abuse reporting issues first, before we go negatively labeling facilities online. If facilities in the Southeast region don’t get relief soon, we’re going to be in a tight spot.”

The initial response to the icons from the post-acute and long-term care industry was swift and negative, with American Health Care Association CEO Mark Parkinson asking Verma to replace the logos with something less severe.

“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,” Parkinson wrote in a letter to Verma earlier this month.

Speaking at the trade group’s annual conference in Orlando, Fla. last week, AHCA senior vice president for government relations Clifton Porter called the icon “dumb.”

“The red hand says ‘Don’t go there.’ The red hand is punitive; the red hand is not about transparency. The red hand is about piling on a consequence in a back-door kind of way,” Porter said. “It’s insulting to me — I’m sure more insulting to you … It’s misleading, and I’m fine with being on the record saying that.”

In a separate session at the conference, CMS nursing home division director Evan Shulman mentioned the 5% figure, and pushed back against the industry’s reaction to the icons.

“It is not a ‘do not proceed’ icon,” Shulman said.

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