The new Nursing Home Compare consumer alert icon violates a patient safety principle that calls on providers to establish blame-free environments for reporting incidents, medical directors stated in a new letter to the Centers for Medicare & Medicaid Services. 

The Society for Post-Act and Long-Term Care Medicine sent the letter Friday to Administrator Seema Verma asking the agency to stop using the icon.

“Abuse and neglect in nursing homes is never acceptable. Bringing it to light through reporting needs to be encouraged. We therefore urge CMS to rescind its decision to use the red hand icon, a damaging and punitive strategy that violates patient safety principles and is likely to reduce reporting rather than prevent abuse and neglect,” President Arif Nazir, MD, and Executive Director Christopher Laxton wrote.

The group stated that the Agency for Healthcare Research and Quality has spent “hundreds of millions of dollars to establish a patient safety network responsible for education, training and the promotion of systemic approaches to prevent adverse events, including abuse and neglect” and the icon doesn’t promote accountability. 

“Central to this mission is AHRQ’s message that healthcare facilities must establish blame-free environments. The ‘red hand’ approach to abuse and neglect violates the principle. The red hand does not provide accountability; it is instead a systemic attempt to blame facilities and/or healthcare personnel,” they wrote. 

They also argued that the icon’s effectiveness has yet to be tested and isn’t evidence-based, and that it undermines preferred skilled nursing facility networks established by Accountable Care Organizations. 

The group stated that establishing a “just culture” is key in provider efforts to prevent patient harm and improve quality. They also called on CMS to create a published registry of nursing home medical directors that will help them better understand the latest issues surrounding nursing home abuse and neglect. 

The icon, which went into effect last month, has been universally slammed by providers. Laxton explained in an email to McKnight’s Long-Term Care News that his organization wanted to get feedback from its members before sending its letter to CMS.

A CMS spokeswoman said the agency will review the letter. She added that the icon helps patients make the best care choices for themselves and has been praised by consumer groups.

“CMS’ top priority is patient safety, and that starts with empowering patients with transparency – especially regarding abuse. Our new abuse icon helps patients make the best choices for their care, incentivizing nursing homes to compete on quality. CMS will assign the icon for the most severe citations of abuse,” the spokeswoman told McKnight’s in an email.

“While fewer than five percent of the more than 15,000 nursing homes participating in Medicare and Medicaid will be subject to the icon, CMS nevertheless urges all providers to focus on preventing abuse. CMS also urges all nursing homes to join in transparency efforts because patients deserve nothing less.” 

The agency added that it will continue to gather feedback from stakeholders on how to provide useful information to consumers, patients, residents and families to support their healthcare decisions.