The Trump administration’s communications freeze, which has indefinitely blocked a majority of external communications by the Centers for Medicare & Medicaid Services (CMS), continues to cause turmoil for nursing home operators.
This freeze, imposed last week, has disrupted the flow of key health care data, and extends to several federal agencies, including the Centers for Disease Control and Prevention (CDC).
At nursing homes, it is causing problems for some facilities by delaying updates to their Star ratings and other public health measures that rely on the CMS data. Some operators have expressed concerns about how the freeze has complicated their ability to monitor facility performance and manage their public image, and worry that it could soon have an impact on their operations and financial performance.
The gag order’s effects were felt as early as Jan. 29, when along with the quarterly refresh, nursing homes were expecting an unfreezing of four quality measures that were on hold since April 2024, in order to allow for measure adjustments for minimum data set (MDS) changes. Lack of clarity on this much anticipated move has added to administrative burdens and overall uncertainty already, operators said.
And while there are currently no operational disruptions, the longer the halt persists, the greater its effects will be down the road. In the grand scheme of things, combined with the chaotic rollout of last week’s executive orders freezing new regulations – which included a temporary shutdown of the Medicaid portal – and potential cuts to Medicaid being pushed by Republican lawmakers, the overall impact of the communications freeze is jarring, experts said.
“It’s absolutely a jolt to the industry,” Fred Bentley, managing director for the post-acute and long-term care and senior living practice at ATI Advisory, told SNN. “Every day that goes by without that communication, there’s just more ambiguity and uncertainty.”
Organizations worry that they may need to put a pause on any financial investments or other operational decisions, he said.
“It’s chaotic, especially for [the nursing home sector] where many organizations are running on fairly thin margins,” Bentley said. “It really does start to raise questions around, ‘Do we invest here? Do we need to hire here? Do we put this program in place? Do we still need to be reporting the data?’”
And while operators in the sector haven’t reported financial fallout in the immediate term, Star ratings can impact the facilities’ bottom line too over time.
Disruptions in Star rating transparency
Operators shared the difficulties they have encountered in trying to monitor their Star ratings and to prepare for any potential changes.
Heather Haberhern, senior vice president of quality at Health Dimensions Group (HDG), said that her organization relies on the Care Compare tool being accurate. Care Compare is part of CMS’ system for publicly displaying nursing home ratings. However, since the communications freeze began, her team has experienced challenges to fully understanding changes in the Star ratings, which are essential for maintaining transparency with both staff and families, especially with the January refresh including information for the unfreezing of four quality measures and a change in the scoring cut points.
While her team still has internal access to certain data through the iQIES, or Internet Quality Improvement and Evaluation System, the ratings are not being updated on the public-facing Care Compare platform. This lack of transparency leaves families and potential residents in the dark about how facilities are performing relative to others in their region. The iQIES is CMS’ tracking, analysis, and data repository system for survey and certification, among other functions.
“We had some communities that had reductions in their Star rating, but most of those appear to be related to the claims-based quality measures at this point. We’re digging in a little bit more this week to determine the final impact of the threshold changes and the updates of the quality measures that were previously frozen,” said Haberhern.
Operators also highlighted additional problems for facilities that had previously been on the special focus facilities list, which tracks facilities with chronic quality problems. These facilities are still being marked as special focus even if they’ve been cleared, according to Danielle Dang, vice president of clinical reimbursement at EF Senior Care. As a result, some facilities are still listed as high-risk despite improvements in care quality.
“So they haven’t updated the facility’s special focus sites … And if you were a building that was recently cleared, you’re not off the hot list. You’re still on it,” Dang told SNN.
The skilled nursing facility (SNF) operators agreed that the freeze has made their jobs harder, especially when it comes to implementing changes to MDS, with the transition from G to GG underway. This quarterly refresh would have included the unfreezing of four quality measures that were frozen in April 2024 to allow for measure adjustments based on Section GG implementation.
Without access to updated data, SNFs are unable to prepare for potential negative changes in their ratings and respond proactively, Haberhern said.
She also expressed concern about the long-term impact of the freeze, noting that it could continue to affect facilities even after the freeze is lifted.
Some chat forums and blogs for nursing staff speculate that the communication freeze may last longer than initially expected.
“Some forums are saying it could be a longer term issue, and not just days and weeks. So it’s going to be interesting to see how this plays out, especially with the Care Compare update and the unfreezing of the new quality measures,” Haberhern said.
The ripple effect
In the midst of the ban on communications, operators have managed to get by despite the less-than-ideal circumstances, according to Rachel Reeves, senior vice president of public affairs at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
“Certainly, external communications from the federal government help bring clarity on certain issues to providers and consumers alike, but providers are continuing to do what they do best during this transition—provide high-quality care,” Reeves said in an emailed statement. “We look forward to federal agencies resuming traditional external communications and perhaps more importantly, working with stakeholders to advance solutions for patients and providers. This is why we’ll continue to encourage lawmakers to swiftly consider cabinet appointees for these critical agencies.”
As of now, it remains unclear when the communications freeze will end. The federal government and its agencies have not provided a clear timeline. At publication time, CMS did not respond to requests by SNN for more clarity on when its website will be next updated.
The federal agency also did not provide answers to LeadingAge’s request on whether an off-cycle quarterly refresh will occur, either at the time the pause is lifted or during a monthly update, or whether it will remain frozen until the next scheduled quarterly refresh on April 30.
The communication freeze has indeed compounded challenges for nursing homes, said Jodi Eyigor, senior director of nursing home quality & health regulation at LeadingAge.
“The continuing pause by the Trump administration on communications from federal health agencies has proven challenging for our nonprofit and mission-driven members,” Eyigor said in an emailed statement. “Nursing homes continue to provide care for our nation’s most vulnerable 24 hours a day, and new challenges and questions can arise at any moment.”
During this data freeze, nursing homes do have access to several key information like sub-regulatory guidance and respiratory virus recommendations, she said. However, lack of other resources, including CMS’ open door forums, which were cancelled, is creating difficulties for nursing homes.
“This latest Care Compare update would have been particularly important as a quarterly refresh,” she said. “We urge the administration to allow communication to resume so that our health care providers and the agencies that regulate them can once again work together to ensure quality care for America’s older adults.”