New CMS Push to Target Nursing Homes in Hotspots ‘Misleading,’ ‘Under-Resourced’

The federal government last week announced a push to support nursing homes in emerging COVID-19 hotspots, using a two-pronged approach of targeted enforcement and technical support from Quality Improvement Organizations (QIOs).

But the group that represents those QIOs claims that the Centers for Medicare & Medicaid Services (CMS) hasn’t provided them with nearly enough money to carry out that task.

“Although we are very glad, obviously, that CMS is activating the QIO program, the funding that CMS has provided so far is not large enough to be able to provide strategic deployment of the program,” Alison Teitelbaum, executive director of the American Health Quality Association, told SNN. “Only some select nursing homes are going to be able to receive assistance at this level of resourcing.”


The non-profit AHQA represents the QIOs, third-party organizations that work to improve care quality for Medicare beneficiaries in a variety of settings, including nursing homes, under the larger Quality Innovation Network-Quality Improvement Organization (QIN-QIO) program.

CMS has cited QIOs as important resources for nursing facilities during the ongoing COVID-19 pandemic; this past week, the agency announced that it would direct QIOs to provide support in hotspots as identified by the White House Coronavirus Task Force.

CMS supplemented the QIO deployment with a promise to target for inspection nursing homes with a history of infection control problems.


“Nursing homes are especially vulnerable to the prevalence and spread of COVID-19,” CMS asserted in a statement. “Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.”

But those QIOs were facing a financial crunch even before the pandemic, according to Teitelbaum. The federal government allowed its multi-year contract to fund the QIO program to lapse last summer, and then reinstated the budget with a 70% cut, she said. Prior to that reduction, the most recent contract provided QIOs with $960 million, Modern Healthcare reported last August.

At current funding levels, the QIOs have $13 million to support their COVID-19 efforts over the next four years, Teitelbaum said — or just $65,000 per state annually, which works out to less than one full-time equivalent position.

“If you think about the number of nursing homes per state, and now you have one person, essentially, per state working to help support all of these nursing homes — a much larger deployment is needed to adequately allow the QIOs to support the nursing homes nationwide,” she said.

For that reason, Teitelbaum described the Friday announcement from CMS as “misleading.”

“It’s not new resources. It’s a diversion, really, of resources,” she said. “It’s an already under-resourced effort that’s now just being diverted.”

For beleaguered nursing homes, QIOs could provide needed material and operational support, from additional staffing to advice on improving infection control to overhauling cleaning and meal service strategies for the new pandemic normal.

While vital even in normal times, the need for backup will only increase as the new COVID-19 hotspots in the South and Sun Belt continue to see a spike in cases. Early research indicates a direct correlation between community spread and the severity of outbreaks in skilled nursing facilities — and CMS has promised to crack down on infection control violations, with targeted inspections in that domain slated for full completion by the end of this month.

It’s a task that has already strained chronically understaffed facilities across the country, but four months into a pandemic that shows no signs of slowing, even the best facilities could use outside support.

“They’re able to bring in this expertise that either the nursing home might not have on site, [or] they might not be able to think through right now because they have been running far beyond their capacity — because they’ve had to — for so long, for months and months now,” Teitelbaum said.

To help fund those efforts, AHQA supports the Infection Control Training and Support Act, a bipartisan bill introduced in Congress last month that would provide about $210 million for the QIOs’ work.

But aside from the funding issue, Teitelbaum also acknowledged an awareness gap among nursing home operators and organizations. Because the White House task force — led by Vice President Mike Pence and Dr. Deborah Birx — must first identify the areas for extra nursing home attention, both the AHQA and facilities can only wait for official word on whether they can receive help under this initiative.

In the meantime, the group is working to educate facilities about the QIOs’ work.

“Unfortunately, we don’t know, before the tap comes, what counties they’re going to be — or even what states they’re going to be in,” Teitelbaum said. “And so unfortunately, the long-term care community doesn’t know either.”

And unlike a visit from a survey agency, which may create fears of citations and fines, Teitelbaum emphasized that the QIOs can serve as a trusted resource for collaborative care improvement.

“They’ve been working with nursing homes across the country for decades. They have great relationships with nursing homes. They can get in there and work quickly because they have already established trust with nursing homes,” she said. “They are not a government agency coming in, doing any kind of survey or certification; they’re not providing citations. They’re not doing audits. They’re really just coming in there to provide support.”

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