Cited Nursing Homes to be Labeled “Do Not Proceed” on CMS’ Nursing Home Compare

CMS announced on Monday that starting October 23, 2019, Nursing Home Compare (NHC) will flag skilled nursing centers that have been cited for abuse, neglect and exploitation. A nursing center will receive an alert icon on NHC if it falls under one of two categories:

  1. If a nursing center has been cited for abuse that led to harm (G or above) in the last year for one of three abuse F-tags; or
  2. If a nursing center has been cited for abuse with the potential for harm (D and above) in each of the last two years.

The three abuse and neglect citations that will result in an icon are as follows:

  1. F600: Free from abuse and neglect
  2. F602: Free from misappropriation/exploitation
  3. F603: Free from involuntary seclusion

Nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that has received the abuse icon can have is four stars.

After a nursing center has been free from any of these three citations (at any level) for a full year or inspection cycle, the icon will be removed. The NHC website will be updated with new information on a monthly basis.

“Making the decision to locate a family member in a nursing facility is one of the most difficult decisions you can make,” said John Vander Meer, President & CEO of WHCA/WiCAL. “This notification system over-simplifies an already difficult decision, and could stop important care conversations from happening before they even start, while at the same time raising significant questions of due process for the provider community. On behalf of WHCA/WiCAL members, I strongly urge CMS to reconsider the hasty launch of this notification system. WHCA/WiCAL staff will be working with AHCA/NCAL officials to ensure that the objections of Wisconsin providers are heard loud and clear regarding our concerns about this new system.”

AHCA/NCAL has identified 12 facilities in Wisconsin that have the stop sign icon related to actual harm. These projections represent AHCA’s best estimates based on Nursing Home Compare data. AHCA projected these facilities are among the 800 of the 15,500 facilities across the country affected by this change. CMS will provide preview reports to each facility one week before the October 23rd posting through the CASPER/QIES report system.

“We support transparency so that potential residents and their families can make an informed decision on care,” said Mark Parkinson, President and CEO of AHCA/NCAL. “We appreciate CMS’ efforts to improve Nursing Home Compare but as we have previously suggested, we believe that CMS should create a standard and rational definition of both abuse and neglect and then report them separately. That would help provide consumers with the information that they need.

“In addition, CMS should add customer satisfaction to Nursing Home Compare because that is the best way for consumers to select facilities. It’s surprising that we can look for customer reviews of restaurants and hotels that we select, but that information isn’t available for nursing homes. We should have a way to let families and residents think of the facilities they are considering.”

AHCA is working on a report for members with information on their likelihood of having an icon displayed, as well as talking points for the media and consumers, and guidance on communicating with residents, their families and prospective referral sources.

In the meantime, members can access new resources on ahcancalED to support long term and post-acute facilities in preventing and addressing reported incidents of resident-to-resident mistreatment

In addition to the new abuse icon, CMS will be removing two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These
measures are:

  • Percentage of short-stay residents who report moderate to severe pain.
  • Percentage of long-stay residents who report moderate to severe pain.

As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting in October. These changes will be made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table below. Note that this table will replace Table 6 in the Technical Users’ Guide (TUG) starting after these changes are implemented in October 2019.

Click HERE for “Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide”

If you have any questions, please contact the AHCA Regulatory team at regulatory@ahca.org.