A Medical Device Daily

The Centers for Medicare & Medicaid Services released the first ranking of the nation’s poor-performing nursing homes.

The poor-performance list consists of more than 50 nursing homes in 33 states and the District of Columbia.

Release of the national list of facilities, identified as special focus facilities (SFFs), is expected to offer individuals, seeking long-term healthcare services, and their families’ powerful new information when choosing nursing homes. It was also developed to push nursing homes into offering better care.

“Every one of the nation’s nursing home residents deserves the highest quality of care, and we applaud the effort by CMS to specifically list those facilities requiring improvements. More transparency, increased accountability and sustaining our ongoing quality improvement efforts in continued collaboration with the federal government is highest priority,” said Bruce Yarwood, president/CEO of the American Health Care Association (Washington).

Release of the list was prompted by the number of facilities that were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and is no longer identified as an SFF, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid. CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

As of October, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest 5% or 10% in each state.

The most recent list includes 54 facilities that are at the top of the poorest performers in those states and among those facilities that have failed to improve significantly.

Typically, these facilities achieve improved survey results after being selected for the initiative. The CMS data indicate that about 50% of the nursing homes identified as SFFs significantly improve their quality of care within 24-30 months, while about 16% are terminated from Medicare and Medicaid.

In addition to publishing the list of SFFs, CMS is taking many other steps to improve the quality of care in the nation’s nursing homes including a new program that will make the payment system more sensitive to quality improvements; developing new, more stringent systems for criminal background checks on facility workers and applicants; unprecedented focus on preventing catastrophic pressure ulcers in nursing home residents; and improving the state survey process.