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 CMS Outlines Efforts to Correct Poor-Performing Nursing Facilities

In a conference call with media on June 5, a top Centers for Medicare & Medicaid Services (CMS) official said the agency is in the process of posting the names of the so-called Special Focus Facility (SFF) program designees deemed to be the poorest performers across the nation.

Kate Goodrich, MD, director of CMS clinical standards and quality, as well as the CMS chief medical officer, said the Trump administration has made the safety and quality of nursing homes a top priority and as such is nearly ready to announce the latest SFF program facilities. She stressed that Nursing Home Compare remains the best avenue for consumers to find comprehensive information on nursing facilities.

As for SFF designees, once deemed as having serious and consistent quality issues, the buildings are visited by CMS survey teams twice as much as normal skilled care centers (about twice a year). “The longer the problems persist, the more stringent we are in the enforcement actions that will be taken,” according to a CMS website description of the SFF program. 

Within 18 to 24 months of a facility being placed in the SFF program, one of three options occur: improvement and graduation from the list (which is updated on a monthly basis), termination from Medicare, or an extension of time is given by CMS to correct issues. 

Goodrich said roughly 3,000 out of the 15,000 nursing facilities in the country are One-Star operations, the lowest in the Five-Star Rating System, but there are only 88 SFF slots, which are filled in consultation with the states out of a pool of 400 candidates.

While Goodrich said, “CMS will be posting the list soon,” her focus in the press briefing was on the ways in which a facility can get in the SFF program, and eventually graduate off the list as quality conditions improve.

“We provide each state a list of five nursing home facilities that essentially performed the worst on health inspection surveys,” she said. “These facilities have systemic issues with quality and safety discovered through annual surveys.”

From that point, states recommend back to CMS which facilities they would like slotted in the SFF program, with CMS making the final decision on the recommendations.  She said 90 percent of the SFF designees graduate and 10 percent do not and are terminated from the Medicare program.
Goodrich said the agency would like more slots in the program but due to budgetary constraints it is not possible. President Trump’s fiscal 2020 budget, however, has requested $44 million in additional funds for CMS survey and certification efforts, which if approved could help expand the SFF program, she said.
Goodrich said CMS is just getting started in its renewed focus on nursing facility oversight, noting changes to the Star Ratings with more emphasis on outcomes versus process-based factors and continuing programs to reduce the use of antipsychotics as well as reduce unnecessary hospitalizations and adverse events.
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