Verma: CMS Wants to Partner with Nursing Homes, ‘Move Away’ from Focusing on Fines

The federal government’s top Medicare official this week emphasized a desire to work closely with leaders in the nursing home landscape, pointing to industry feedback as a key driver behind a sweeping plan to send point-of-care COVID-19 testing units to the nation’s nursing facilities.

“CMS obviously has a regulatory function with nursing homes,” Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma said during a Wednesday afternoon call open to industry leaders. “We also want to be partners with you, and move away from an agency that’s just sending out fines and finding problems, but actually working with you around solutions.”

Verma drew on that context to when describing the joint CMS and Department of Health and Human Services (HHS) initiative to eventually distribute point-of-care testing devices to the more than 15,000 nursing facilities in the country, starting next week with 2,000 properties identified as at the highest risk for outbreaks.

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The administrator in particular praised Mark Parkinson, CEO of leading industry trade group the American Health Care Association, for his input.

“Over the last couple of weeks, we’ve had conversations on the state level with many of the state associations, and appreciate all of you that have participated in those calls, because that’s what gives us insight and tells us about the barriers and issues that you are facing — and we appreciate all of you that brought up the testing issues,” Verma said.

Parkinson himself was on the call, and took the opportunity to praise Verma’s willingness to work with industry leaders.

“We have had a terrific partnership. Your responsiveness has been incredible. There are literally times that I’ve sent you e-mails and you’ve called me within a minute,” Parkinson said to Verma. “And it’s really important because the work that the members do in normal times really matters; during this pandemic, it’s a matter of life and death.”

Verma thanked the assembled nursing home leaders and staff for their work during the pandemic.

“It’s just been an extraordinary challenge — and of course, there’s always the media, that’s not always kind to us,” she said. “But I just wanted you to know, from the administration standpoint, that we really appreciate all of your efforts.”

Struggles with securing and processing COVID-19 tests for all nursing home residents and staff members — particularly increasing turnaround times for results from third-party labs — have been a recurring issue for nursing homes across the country as new hotspots flare.

CMS and HHS indicated that they hope to solve that strain with the new point-of-care push.

“We heard from you that you were facing significant challenges with turnaround times, and even being told by labs that they couldn’t support the testing, or the need for testing every week of your nursing home workers,” Verma said. “So we know that this has been a difficult time as you have tried to abide by the CMS recommendations.”

The federal government has moved to boost fines for infection-control violations during the COVID-19 pandemic, while also reorienting its inspection process to focus on that domain; facilities with a history of infection-control problems can now face penalties of up to $20,000 per instance.

Some researchers, including David Grabowski from Harvard and R. Tamara Konetzka of the University of Chicago, have argued that fines may not be the best approach for increasing quality during a pandemic, given the financial strain on many facilities facing skyrocketing costs for staffing and personal protective equipment (PPE).

“I think these policies are at best premature, and at worst, probably a little dangerous,” Konetzka told SNN last month. “Most of the research that’s been done on quality and the probability of a nursing home having a COVID outbreak, or COVID-related deaths, has shown that there’s actually not much of a relationship with quality.”

But resident advocates have countered that fines can serve as a powerful motivator for operators to solve infection control problems, which were widespread in nursing facilities even before the pandemic.

The Center for Medicare Advocacy, a Washington, D.C.-based group, earlier this month released a report noting that only about 2% of facilities have received any citations for infection control problems during the pandemic, with fewer than 1% hit with fines.

“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.

National publications have also focused on the Trump administration’s attempts to pause and modify certain aspects of the sweeping Requirements of Participation overhaul, particularly the proposed easing of a rule that would mandate an infection preventionist position at every facility.

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