HHS Announces Actions for Nursing Home Safety and Transparency
According to a Jan. 18 press release, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new actions to reduce the incorrect use of antipsychotic medications and to bring more transparency about nursing home citations to families. These actions are part of the efforts under President Biden’s initiative to improve nursing home transparency, safety and quality, and accountability.
The press release states that “Beginning this month, CMS will conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis. Nursing home residents erroneously diagnosed with schizophrenia are at risk of poor care and prescribed inappropriate antipsychotic medications. Antipsychotic medications are especially dangerous among the nursing home population due to their potential devastating side effects, including death. This action advances the Biden-Harris Administration’s goal of reinforcing safeguards against unnecessary medications and treatments that was outlined in President Biden’s State of the Union Action Plan for Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes.”
This action builds upon the Administration’s goal of improving the accuracy of the quality information that is publicly reported and the nursing home Five-Star Rating System. The use of antipsychotic medications in nursing homes can be an indicator of the facility’s quality and is used in a nursing home’s Five-Star rating—excluding residents with schizophrenia. If an audit finds that a facility inaccurately codes patients as having schizophrenia, the nursing home’s Five-Start Quality Measure Rating on the Care Compare site will be impacted.
In a separate action, CMS is planning to take steps to increase the transparency of nursing home information by publicly displaying survey citations that facilities are disputing. At present, when a facility is disputing a survey deficiency, the deficiency is not posted to the Care Compare site until the disput process is complete—generally 60 days, but oftentimes longer.
The press release notes that “While the number of actual deficiencies under dispute is relatively small, they can include severe instances of non-compliance such as Immediate Jeopardy (IJ) citations. This level of citation occurs when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment or death. Displaying this information while it is under dispute can help consumers make more informed choices when it comes to evaluating a facility. This new information will begin appearing on Care Compare on January 25, 2023. While the citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete.”
Further, “Today’s actions by CMS are the latest among several actions the agency has taken over the years to strengthen public reporting and the Five-Star Quality Rating System. These actions include:
- Adding the results of focused infection control surveys to the Care Compare website and Five-Star Quality Rating System,
- Increasing the Quality Measure rating thresholds to incentivize improved quality, and
- Adding measures of staff turnover to inform consumers of the stability of a nursing home’s staff (which is linked to the quality of care a nursing home provides).”
CMS Administrator Chiquita Brooks-LaSure was quoted in the release saying that “We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done. People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications.”
