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 CMS Head Verma Says Agency Focused on Quality, Safety at SNFs

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said she has directed her team to undertake a comprehensive review “of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes” to ensure the country is living up to the goal of providing high-quality and safe care for the nation’s most vulnerable.

In a blog post issued on April 15, she also outlined administration efforts to improve skilled nursing facility (SNF) safety and quality, saying safety across all care settings is a “sacred trust” for which the agency takes responsibility. Verma noted that while CMS supports and promotes the private sector’s role in the health care system, safety issues are a core role of the government.

Verma said the most fundamental job of skilled nursing care is that it ensures residents are treated with dignity and kept safe from abuse and neglect. At the same time, providers should be “rewarded for value and quality,” while communicating patient outcomes in a transparent fashion to consumers “without unnecessary paperwork that keeps providers from focusing on patients,” she said.

In a statement regarding the Verma blog post, Mark Parkinson, president and chief executive officer, American Health Care Association (AHCA), said the nation’s skilled nursing providers have committed their lives to taking care of seniors” and paved the way for dramatic quality improvements across a span of measurements.

“We have been at the forefront of quality improvement efforts for many years, and the results speak for themselves,” he said. “On 19 of the 24 quality measures, there has been tremendous improvement, and our momentum is accelerating.”

Parkinson said while the profession understands the need for regulation, any oversight needs to be focused on person-centered care and providing feedback on areas to improve.

“If CMS means to convey a focus on helping providers achieve compliance and a shift away from the current punitive survey process in this post, the agency will be an important partner as we continue in this quality improvement journey. Regardless, AHCA maintains an unwavering commitment to further improve the lives of millions of residents in our buildings.”

In addition to the Verma sentiments on the agency’s overall mission in regard to skilled nursing case, she said CMS has developed a five-part plan for skilled care, including to:

--Strengthen oversight. CMS is working with state survey agencies (SSAs) for more consistent oversight practices. “Residents deserve consistent nursing home quality, regardless of location, so CMS is revising our oversight of SSA performance,” Verma said.

The agency is also examining the way surveyors identify issues such as abuse, facility staffing levels, and dementia care, and is clarifying expectations regarding when abuse must be reported to the state and law enforcement. “We will also be updating Nursing Home Compare to make it easier for consumers to identify specific instances of noncompliance related to abuse or inappropriate antipsychotic medication use,” Verma said.

There is also a rethink underway on the guidance CMS gives to SSAs. She said when surveyors decide that a SNF is providing poor care that could seriously harm residents or is likely to cause serious harm, meeting the “Immediate Jeopardy” classification, then that finding should be based on consistent application of standards nationwide.

--Enhance enforcement. Verma said CMS has long identified staffing as one of the vital components of a SNF’s ability to provide quality care and since November 2018 has shared staffing data with SSAs “so they know which nursing homes may have potential staffing problems and can target their reviews.”

On quality of life, CMS has been working to curb the use of antipsychotic sedative drugs in contravention of FDA guidelines. “CMS has worked through our National Partnership to Improve Dementia Care in Nursing Homes to curb the inappropriate use of these drugs in nursing homes,” she said. And, on March 1, the agency said it would conduct enhanced oversight and enforcement of SNFs that have not improved their antipsychotic medication utilization rates for long-stay residents since 2011.

In addition, President Trump’s Fiscal Year 2020 budget includes a request that Congress provide CMS the authority to adjust the frequency of mandatory SNF surveys “so we can focus more of our time and resources on nursing homes that are poor performers while continuing efforts to respond to complaints.”

--Increase transparency. Verma said CMS—in working to make the Nursing Home Compare website as accurate and informative as possible—has incorporated data on SNF staffing based from a new payroll-based journal system for the website and the Nursing Home Five-Star Quality Rating System.

--Improve quality. CMS, she said, is working with the SNF profession to develop quality measures that score providers based on patient outcomes, not adherence to processes. “CMS fines nursing homes that don’t comply with our requirements, and we recently launched an initiative to invest these Civil Money Penalty dollars in efforts to reduce adverse events, improve staffing quality, and improve quality of care for residents with dementia,” Verma said.

Value is also playing a part in the effort, with the agency’s SNF Value-Based Purchasing Program, which ties a portion of a SNF’s payments to performance.

--Put patients over paperwork. Verma said the final prong of the five-part program involves

ensuring access to keep quality nursing home care as the priority, but without burdensome regulations. “When administrative burden increases with little or no benefit, patients suffer because mountains of unnecessary paperwork keep providers from patients,” she said.

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