The Centers for Medicare & Medicaid Services announced last week that effective Oct. 23, it will add an “abuse” icon on Nursing Home Compare to identify skilled nursing facilities that have received recent abuse, neglect or exploitation citations.

In addition, those facilities that receive the icon will have their CMS Five-Star health inspection rating limited to a maximum of two stars and their overall rating limited to four stars.

This could be bad news for nearly 3,000 facilities, or about 18% nationwide.  

Formation Healthcare, the clinical consulting division of Formation Capital, assessed the potential national impact of these changes and found last week that applying the CMS abuse icon criteria to Nursing Home Compare data available as of Oct. 1, 745 facilities would have the abuse, neglect or exploitation icon displayed. That represents approximately 5% of skilled nursing facilities nationwide.

(Editor’s note: A CMS official said Tuesday that using the latest data, less than 5% of facilities are currently in line to get the “abuse” icon in the initial posting.)

An additional 2,077 skilled nursing facilities, representing 13% of SNFs nationwide, have been cited for abuse, neglect or exploitation during standard or complaint surveys during the past 24 months. That puts them at risk for the abuse icon if another citation related to abuse, neglect or exploitation is received.

Jessica Curtis

Of the 745 facilities potentially slated to receive the abuse icon at the end of October, 110 are currently rated three, four or five stars in the health inspection domain and would lose one or more stars by dropping to the two-star maximum health inspection rating. The remaining facilities are either unrated due to being special focus facilities (19) or already rated one or two stars for health inspections (616). 

Also of note, 25 of the facilities are currently rated five stars overall and would lose a star as CMS limits them to a maximum overall rating of four stars. Additional changes by CMS to the quality measures domain coupled with the release of new quarterly staffing data on Oct. 23 will likely result in even more shifts amongst overall ratings.

Stakeholders will be paying close attention to the data released in October, and providers should be aware of the impact the upcoming changes will have on their ratings. Every facility is at risk of getting the “red hand” consumer alert icon and experiencing rating declines if it has instances of non-compliance related to abuse going forward.

Providers should identify those facilities that have been cited for abuse, neglect or exploitation in the past and educate staff on policies and procedures to ensure ongoing compliance with regulatory requirements.