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 Nursing Care Profession Responds to CMS Special Focus Facility Announcement

Following the release of a list of 400 skilled nursing facilities (SNFs) the Centers for Medicare & Medicaid Services (CMS) has deemed to have persistently poor survey inspection results, and a subsequent announcement by CMS of how the list is being sorted out for possible inclusion in its Special Focus Facility (SFF) program, the nursing care profession tells Provider that public information on the SNFs listed is already available.

At issue is the list of SNFs released recently by Sens. Bob Casey (D-Pa.) and Pat Toomey (R-Pa.) that are under consideration for inclusion in the SFF program. The program includes heightened CMS oversight via increased survey visits for those facilities chosen.

The two senators had previously asked CMS to make public the list of candidates for the program, the 400 SNFs, but CMS has historically only released the final selections, which number 88.

David Gifford, MD, senior vice president of quality and regulatory affairs, American Health Care Association (AHCA), says AHCA supports making relevant, transparent information available to families and consumers so they can make informed care decisions for their loved ones when selecting a facility for nursing care.

But, he points out that the information provided by the release of the 400 SNFs on the candidates list is not new.

“The public already has access to information on Nursing Home Compare that helps them identify facilities at risk of quality problems or with demonstrated issues related to staffing,” he says. “CMS should consider adding a customer satisfaction rating to the Five-Star System to provide families another way of learning about a facility’s performance.”

Further, Gifford says when choosing a facility, consumers should look at the entire picture and consider many factors. “Visiting in person is the best way to learn about a center and be sure it’s the right fit for the consumer’s care needs,” he says.

A top CMS official on June 5 conducted a press briefing to announce that the agency is in the process of posting the names of the SFF program designees.

Kate Goodrich, MD, director of CMS clinical standards and quality, as well as the CMS chief medical officer, said during the press briefing that Nursing Home Compare remains the best avenue for consumers to find comprehensive information on nursing facilities.

As for the SFF program, Goodrich said roughly 3,000 out of the 15,000 nursing facilities in the country are One-Star facilities (because CMS labels the bottom 20 percent automatically as One-Star in its Five-Star Rating System), but there are only 88 AFF 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 briefing was on the ways in which a facility is selected for the SFF program and what actions may be taken to penalize them through Civil Money Penalties (CMPs) or other corrective actions.

The goal is to “graduate” poor-performing SNFs off the list as quality conditions improve, she said. “We provide each state a list of five nursing home facilities that essentially performed the worst on health inspection surveys. These facilities have systemic issues with quality and safety discovered through annual surveys.”

States recommend back to CMS the facilities they would like slotted in the SFF program, with CMS making the final decision. Goodrich said 90 percent of the SFF designees eventually graduate, and 10 percent do not and are excluded from the Medicare program, and another 25 percent are sold to a different owner/operator.

On the broader issue in play of whether the SFF lists work for their intended purpose, Clifton Porter II, senior vice president of government relations for AHCA, says they are not the solution to the problem, given other more substantial changes needed.

“We need to get at the root causes of poor quality, and the one that is often ignored is the severe underfunding within the Medicaid program, which is a strong predictor of the survey inspections and staffing levels,” he says.

Porter also notes there “is the fact that CMP resources are collected for quality improvement purposes, but they are rarely distributed to solve problems.”

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