Casey, Toomey voice concern over transparency of underperforming nursing homes

2019-03-20 | The Sentinel (Carlisle, Pa.)

March 20-- Mar. 20--The Centers for Medicare Medicaid Services runs a program called Special Focus Facility Initiative, in which it helps struggling nursing homes to better care for its residents, through more regular visits and more stringent inspections to correct problems.

CMS publicly lists which nursing facilities are in this program, and two in the Midstate are enrolled: The Gardens at West Shore in Camp Hill and Falling Spring Nursing and Rehabilitation Center in Chambersburg, formerly owned by Franklin County.

Though CMS notes where these facilities stand -- Falling Spring is improving after 10 months in the program while the Gardens has not improved in 10 months -- it's where other nursing homes fall in performance that have Sens. Bob Casey and Pat Toomey concerned.

The two senators this month sent a bipartisan letter to CMS questioning how facilities are added to the program and if there is any oversight of facility candidates that were not selected by the program but are still struggling to provide adequate care.

Their questions come after an investigation in Pennsylvania into the neglect and understaffing at facilities, three of which the senators noted in their letter are in the SFF program.

"As detailed in these reports, despite recent changes in ownership and prior investigations, some of our older constituents and people with disabilities residing in these homes experienced significant harm, including insect infestations, improper wound care, unsanitary conditions, supply shortages and more," the senators said in the letter provided by Casey's office. "Neglect and abuse of this nature is altogether unacceptable, and through a robust system of competition, monitoring, oversight, technical assistance and enforcement, it should be entirely avoidable."

CMS in an emailed statement Tuesday argued they are using new data tools to strengthen oversight and provide accurate public reporting.

"Every nursing home serving Medicare and Medicaid beneficiaries is required to keep its residents safe and provide high quality care," said Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality and chief medical officer at CMS. "We have focused on strengthening requirements for nursing homes, working with states to enforce statutory and regulatory requirements, increasing transparency of nursing home performance, and promoting improved health outcomes for nursing home residents."


According to CMS, the SFF Initiative was created to address the problem of a minority of nursing homes that had more problems than other facilities (as much as twice the average number of deficiencies), more serious problems including harm or injury to residents, and a pattern of serious problems that persisted over a long period of time. CMS said the patterns are measured over three years before the date a nursing home is first put on the program list.

For facilities that are chosen for the program, CMS requires the nursing homes be visited in person by survey teams twice as frequently as other nursing homes, which is about twice a year. CMS said enforcement actions would become more stringent the longer problems persist, which can include civil monetary penalties or fines or termination from Medicare and Medicaid.

CMS said that within about 18 to 24 months, a facility is identified for one of three outcomes: improvement and graduation from the program, termination from Medicare or extension of time, which can be granted due to progress or sale of the home to another owner with a better record of care.

CMS said about 50 percent of the nursing homes in the program "significantly improve their quality of care within 24 to 30 months after being selected." About 16 percent are terminated from Medicare and Medicaid.

According to CMS's list of nursing facilities in the program, many of the 35 nursing homes that have not improved have been in the program for an average of 14 months, though there are outliers that have been in the program as long as 22 or even 31 months.

The 31 facilities listed as having shown improvement vary in time spent in the program, with some only needing a few months to show progress to others, including one in New York that has been in the program for 53 months.

The 18 that were listed recently as having graduated from the program spent on average 19.5 months in the program. CMS also listed five facilities as no longer participating in Medicare and Medicaid, though it said facilities could have voluntarily chosen to leave or simply closed.

Overall, including facilities that were newly added, CMS said that as of Feb. 21, the program had 85 participating nursing homes in the program.


Though CMS said it had increased the number of nursing homes allowed in the program by 30 percent in 2005 and began publishing the names of the facilities in 2008, Casey and Toomey argued that more information should be available.

They said in their letter to CMS that 15,570 nursing homes are in the United States, but only 0.6 percent participate in SFF and only 2.8 percent are considered eligible for the candidate list.

Casey and Toomey asked a number of questions in their letter of CMS, seeking information by the end of the month on how candidates are selected, as well as what happens to facilities that are not selected but are still likely underperforming, given they were considered. The senators add that Pennsylvania's participation in the program includes a minimum of 20 candidates and four participants.

CMS on Tuesday said it constantly evaluates candidates for addition to the list, and once a facility graduates from the program, another facility from the same state as the graduating nursing home is added to the list.

"SFF candidates are generally the facilities who have had the most serious and pervasive levels of noncompliance over the last three years," CMS said in an emailed statement Tuesday. "These facilities would likely be rated one-star in the inspection domain, and no more than two stars overall in the Nursing Home Five Star Quality Rating System, which is posted on the Nursing Home Compare website."

Casey and Toomey argued that while the list of facilities in the program is public, the list of candidates is not -- it's only public to the potential candidates.

CMS's Nursing Home Compare function on its website,, allows users to look at the star ratings of nursing home facilities by ZIP code or city. On the list, those that are in SFF are denoted with an exclamation point and explanation of what SFF is.

Each nursing home is given an up to 5-star rating on health inspections, staffing and quality measures, as well as an overall rating. Clicking on individual nursing homes will also give users a better picture of the facility, including what fines were issued and how much, as well as inspection reports.

Though that function does not denote which nursing homes are on the candidate list for SFF, CMS said in an email that this system does give consumers and caregivers information that they feel allows people to make informed decisions.

The Pennsylvania Department of Health also issues patient care inspection reports that it publicly reports on its website at least 41 days after the exit date of the survey.