'Special' times ahead for more nursing homes, and that's not good

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James M. Berklan
James M. Berklan

As spring blends into summer, some nursing home operators are going to start feeling more heat — and it will have nothing to do with the weather. They will be given places on the proverbial hot seat. Well-earned seating arrangements, as it were.

That's because the federal government is moving to reclaim some form of “normalcy” after sequestration cuts lopped funding for many things, including its “very bad boys” list. That might be putting it a bit too lightly, however.

To get on the Centers for Medicare & Medicaid Services' “Special Focus Facility” list, you have to have been a bad performer for many, many months. “Special” in this case is just a synonym for lousy, frankly. You have to have been really bad for more than year, according to surveyors. Even then, you will have had numerous chances to clean up your act for further surveyor visits.

Some of those check-ups went by the wayside due to the sequestration cutbacks. But slowly the temperature is rising again. States were allowed to start adding to their SFF lists at the beginning of this month; in fact, they have until July 31 to have fully beefed them up.

Let's be clear that this is not going to affect a vast majority of nursing homes. In fact, it's almost a joke how few facilities nationwide are put on the SFF list. If you've heard of the phrase “the cream of the crop,” well, this is the total opposite. No fellow operator should want these rotten apples sullying the profession — if said apples have repeatedly flunked chances to clean up their act for good.

Currently, the number on the SFF list is 48 — or an average of less than one facility per state. Under new projections, there will be 88 in “Required SFF slots” by July 31.

How did regulators come up with that number? They assigned each state a “candidate list” and divided by five. So there are 435 facilities nationwide that could be wondering if they'll be on the list soon, if they aren't already on it. (That big number is startlingly close to the number of Representatives there are in the U.S. Congress, but we'll have to leave for another time.)

There are 26 states that don't have their “required” number of slots filled. Illinois (the worst), Florida, Indiana, Minnesota, North Carolina, New York, Pennsylvania, Tennessee and Texas all needed to add multiple facilities to the ignominious SFF list.

On the other hand, two states — Mississippi and Oklahoma — each already have one more facility enrolled than is required by CMS. They seem to be more intent on cleaning up messes. But then again, are these two states tougher about making providers toe the line, or is the quality of care in those areas just that much worse than others? That simply brings us back to the ages-old problem of non-uniform surveyor assessments and enforcements among the different states.

Nonetheless, it seems that while some really lousy performers have been able to enjoy a sequestration-induced break from needed scrutiny, that could be slipping away.

Still, the new, bigger target is just 88 of some 16,000 Medicare and Medicaid accredited facilities out there. That's just one-half of 1%, so it seems likely that numerous shady characters will continue to get a breather.

But maybe not for too long. Tucked away at the end of the CMS letter that we first reported on in April is a relatively innocent-sounding two sentences. In convoluted government-speak, it's easy to gloss over them:

“We will also be developing several pilot programs in various CMS Regions and may be making additional policy process adjustments to the SFF program. The pilot programs are designed to evaluate other interventions for the SFF program.” (Emphasis added)

In other words, be prepared for more friction. “You might be sitting comfortably now despite your terrible record,” CMS seems to be saying, “but we're going to keep working on better ways to uncover and discipline you.”

James M. Berklan is McKnight's Editor. Follow him @LTCEditorsDesk.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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