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Center Submits Statement to Congressional Subcommittee on SNF Safety and Quality of Care || Center for Medicare Advocacy

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Analyzing Federal Efforts to Guarantee Quality of Care and Resident Safety in Nursing Houses

Home Committee on Power and Commerce Subcommittee on Oversight and Investigations Listening to

September 6, 2018

Statement of the Center for Medicare Advocacy

The Center for Medicare Advocacy thanks the Committee for holding this necessary listening to on nursing house high quality.  Each the Authorities Accountability Workplace and the HHS Workplace of Inspector Basic have issued many reviews within the final 20 years concerning the poor care that many residents obtain.  Congressional oversight and legislative motion are critically wanted.

The Nursing House Reform Regulation (1987) units the requirements of care for all expert nursing amenities and nursing amenities within the nation that select to obtain reimbursement beneath the Medicare and Medicaid packages for offering care to residents.  The Regulation requires amenities to present every resident with all of the care and providers which are vital for the resident to attain and keep “the highest practicable physical, mental, and psychosocial wellbeing.”  Almost each facility within the nation voluntarily participates in each federal funds and is ruled by these outcome-oriented, resident-focused requirements.

Sadly, the federal requirements for high quality of care and high quality of life aren’t meaningfully enforced.  As a matter of coverage, the Facilities for Medicare & Medicaid Providers (CMS) imposes monetary sanctions solely when it calls amenities’ noncompliance both “actual harm” or “immediate jeopardy,” phrases which are assigned to lower than 5% of deficiencies nationwide.  Most noncompliance known as “no harm” and is actually ignored by the regulatory system, whilst amenities’ noncompliance truly endangers and harms residents.  (See hooked up Elder Justice: What “No Harm” Actually Means for Residents, Vol. 1, Concern Eight, pages 5-Eight.)

Non-enforcement of federal requirements of care is highlighted by the remedy of Particular Focus Amenities (SFFs), the small handful of amenities in every state which are recognized as having extra deficiencies than common, and extra critical deficiencies, over an prolonged interval of time.  The Center for Medicare Advocacy lately seemed on the SFFs that had been recognized as SFFs as of June 21, 2018 and July 19, 2018.  Though the 18 newly-identified SFFs have been cited with the very best degree of deficiencies (66 jeopardy deficiencies and 23 hurt deficiencies since 2016), CMS imposed few and small civil cash penalties (CMPs) towards them.  Solely 12 of the 18 amenities

had any CMPs imposed over the prior three years and the CMPs for these 12 amenities averaged solely $27,562 per facility per yr over the three-year interval.  (See hooked up Center report, Particular Focus Amenities: Poor Care for Residents, Restricted Enforcement Penalties for Residents, Jul. 27, 2018, pages 9-16.)

The Administration has lately taken steps to scale back CMPs going ahead.  Amongst many modifications that scale back enforcement, CMS has shifted from per day CMPs (that mirror the period of a facility’s noncompliance) to per occasion CMPs (which might be one-time fines that can’t exceed roughly $20,000).  Already minimal enforcement for the poorest high quality amenities is declining even additional, as federal enforcement knowledge doc a dramatic shift to per occasion CMPs.  (See hooked up CMS’s Civil Cash Penalty Stories for 2016 and 2018, pages 17-18.)

One other key trigger of poor high quality of care and high quality of life is the nearly non-existent oversight, at each the federal and state ranges, of who owns and manages amenities.  The difficulty got here vividly and painfully into public consciousness final Spring, when Skyline/Cottonwood, a New Jersey-based firm, imploded.  Since 2015, Skyline had assumed administration of greater than 100 nursing amenities in between six and eight states.  Between late March and late April 2018, Skyline/Cottonwood had stopped paying many of its staff and distributors and the corporate collapsed.  The states the place Skyline owned or managed amenities rushed to courtroom to get authority to take over the amenities, actions that have been mandatory to guarantee that residents would proceed to obtain meals, drugs, and care.  How did this disaster occur?  How was an unknown firm, with an more and more poor document, in a position to take over so many amenities in such a brief interval of time?  States and the federal authorities have the obligation and duty to guarantee that house owners and managers are competent to present care, however they seem to approve modifications in possession and administration with out significant assessment. 

Skyline is the newest instance of failed oversight of house owners and managers, however it isn’t the one instance.  In 2015, one other firm with amenities in a number of Midwestern states collapsed.  Its proprietor had began a brand new firm, Deseret Well being Group, in 2006 and repeated the sample he established in California 20 years earlier: poor care for residents, chapter, and abandonment of the nursing amenities and their residents, forcing states to go to courtroom to take over the amenities.  How was this proprietor, with a legal document, allowed to start a brand new nursing house firm and get its amenities licensed by the states and licensed for Medicare and Medicaid?  (See hooked up article, “Buying and Selling Nursing Homes: Who’s Looking Out for the Residents?” CMA Alert, Might 23, 2018, pages 19-21.)

On September 1, 2018, the Boston Globe reported that the New Jersey-based Synergy Well being Facilities began shopping for nursing amenities in Massachusetts in late 2012, though the corporate had no document of proudly owning amenities earlier than.  It continued to purchase amenities and get state licenses and federal certification for Medicare and Medicaid for its amenities, regardless of growing studies of well being and security deficiencies.  Now, eight of its ten Massachusetts amenities are underneath court-ordered receivership, two of its amenities are Massachusetts’ solely SFFs, and the Lawyer Basic is investigating the corporate’s failure to pay its staff’ medical insurance premiums, regardless of deducting premiums from their paychecks.  Kay Lazar, “Troubled Massachusetts nursing home chain in ‘dire’ straits,” Sep. 1, 2018, https://www.bostonglobe.com/metro/2018/08/31/troubled-massachusetts-nursing-home-chain-dire-straits-court-monitor-warns/WtywMujnoo7Fy2qYdlvdxL/story.html.

Nursing amenities report that high quality of care is enhancing, pointing to the standard measures reported on Nursing House Examine.  Nevertheless, these measures are self-reported and unaudited by CMS.  The New York Occasions reported in 2014 that nursing amenities recreation the federal score system and report resident evaluation info that provides them excessive scores in high quality measures.  Katie Thomas, “Medicare Star Ratings Allow Nursing Homes to Game the System,” The New York Occasions (Aug. 14, 2014), https://www.nytimes.com/2014/08/25/business/medicare-star-ratings-allow-nursing-homes-to-game-the-system.html

The follow of gaming continues.  Final month, the Center discovered that 13 of the 33 SFFs (39%) on CMS’s July 19, 2018 listing of SFFs that “have not improved” had 5 stars, CMS’s highest score, of their self-reported high quality measures.  Not solely is it extremely unlikely that these SFFs that “have not improved” offered excellent care, however the self-reported measures additionally boosted the amenities’ general scores on Nursing Residence Examine from one star to two stars, making them seem to present higher care than they really offered.  (See CMA Alert on report, “Special Focus Nursing Facilities that ‘Have Not Improved:’ Poor Care for Residents, Overall Ratings Artificially Boosted by 5-Star Ratings in Self-Reported Quality Measures,” Aug. 15, 2018, web page 22.).

With out query, the only largest impediment to excellent care is insufficient nurse staffing ranges, each skilled nurses (registered nurses, licensed sensible nurses, and licensed vocational nurses) and paraprofessional nurses (licensed nurse assistants).  Almost 70% of amenities had overstated their staffing ranges for a few years, on common by 12%, when Nursing House Examine posted self-reported staffing knowledge, as The New York Occasions and Kaiser Well being Information reported after CMS shifted this Spring from self-reported knowledge to a payroll-based system for reporting nurse staffing.  Jordan Rau, “‘It’s Almost Like a Ghost Town.’  Most Nursing Homes Overstated Staffing for Years,” July 7, 2018, https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html.  Whereas the brand new payroll-based system offers extra correct staffing info, the insufficient nurse staffing ranges, now clearly documented, cry out for significant, enforceable federal laws to enhance staffing in nursing amenities.

Thanks, once more, for holding this listening to.  The Center for Medicare Advocacy stands prepared to help the Committee because it strikes ahead in its oversight of the nursing residence business.

The Center for Medicare Advocacy (Center) is a nationwide, personal, non-profit regulation group, based in 1986, that gives schooling, evaluation, advocacy, and authorized help to help individuals nationwide, primarily older individuals and individuals with disabilities, to get hold of needed well being care, remedy, and Medicare.  The Center focuses on the wants of Medicare beneficiaries, individuals with persistent circumstances, and these in want of long-term care and offers coaching relating to Medicare and well being care rights all through the nation.  It advocates on behalf of beneficiaries in administrative and legislative boards, and serves as authorized counsel in litigation of significance to Medicare beneficiaries and others looking for well being protection.

See attachments and obtain the assertion at: http://www.medicareadvocacy.org/wp-content/uploads/2018/09/Centers-Statement-on-Nursing-Home-Hearing.pdf

Sep. 6, 2018
Toby S. Edelman
Senior Coverage Lawyer
Center for Medicare Advocacy

Dara Valanejad
Coverage Lawyer
Center for Medicare Advocacy
Lengthy Time period Care Group Coalition