CMS Cites 2% of Nursing Homes, Fines Less than 1% in Infection Control Push — With Average CMP of $76K

The most recent set of targeted infection control surveys at nursing homes, conducted in the wake of COVID-19 outbreaks, resulted in only a small proportion of deficiency citations for nursing homes, according to a new analysis released Thursday.

Just about 2.4% of the 4,175 new surveys reported as of June 24 included nursing homes for deficiencies around infection prevention and control, the Center for Medicare Advocacy (CMA) determined.

That works out to cited issues at 99 facilities nationwide, a figure that the Washington D.C.-based resident and beneficiary advocacy group classified as “just a handful.”


“These data are simply not plausible during the COVID-19 pandemic, especially when infection control deficiencies were the most commonly-cited deficiencies before the pandemic,” the group concluded.

Of those that received citations, 35 buildings received civil monetary penalties (CMPs), with an average price tag of about $76,000. The remaining 64 were not subject to fines, the CMA found.

The Centers for Medicare & Medicaid Services (CMS) temporarily refocused its nursing home inspection efforts around infection control during the ongoing COVID-19 crisis, suspending all non-emergency surveys and vowing to conduct infection-focused inspections across the country.


As of early June, only about 54% of those infection surveys had been completed nationwide; CMS threatened to cut funding for states that do not finish the task by July 31.

The Thursday results reflect an earlier analysis by the CMA, which found a 3% citation rate among the first public crop of about 5,700 surveys. A more limited probe of survey results in New York City conducted at the end of May found no citations at facilities, including those with substantial outbreaks.

Among the second batch of surveys, Texas facilities recorded the most infection prevention and control deficiencies with 29 of the 99; California came in second with 12, and Missouri took third with nine.

Source: Center for Medicare Advocacy

The vast majority of issues, or 96%, consisted of “no harm” or “substantial compliance” citations, with just three citations logged under the highest-level “immediate jeopardy” category.

The CMA also analyzed the quality history of the facilities that received citations; 97 of the 99 had federal five-star ratings, as one was too new and another had recently graduated from the Special Focus Facility (SFF) list.

Of that group, 64% had one- or two-star health inspection ratings, while 62% had staffing ratings of one or two stars. Overall star ratings were also concentrated on the lower end of the spectrum, though 23 facilities had four or five stars, the highest achievable.

Source: Center for Medicare Advocacy

Despite accounting for 69.3% of total facilities nationwide in 2016, for-profit buildings represented about 87% of the nursing homes that received citations in the most recent round of surveys, compared to government-operated buildings at 7.7% and non-profits at 6.6%.

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