McKnight's Long-Term Care News, March 2019, page 3, Seema Verma

The federal government is further tightening the screws on regulation of nursing home staffing and quality, with a big shakeup starting as soon as next month.

Changes coming down the pipeline in April will include revisions to the nursing home inspection process, adding new quality measures to its ratings system, and further enhancing details about facilities’ staffing numbers. On the latter, officials say they’re dropping the number of days SNFs can go without an RN before they’re bumped down to a one-star rating.

The Centers for Medicare & Medicaid Services first announced the slew of modifications that it’s making to both Nursing Home Compare and the field’s Five-Star Quality Rating System on Tuesday. Agency officials said their primary aim is to promote quality improvement among SNFs and improve outcomes for residents, according to an announcement.

“Our updates to Nursing Home Compare reflect more transparent and meaningful information about the quality of care that each nursing home is giving its residents,” CMS Administrator Seema Verma said in a statement. “Our goal is to drive quality improvements across the industry and empower consumers to make decisions, with more confidence, for their loved ones.”

Revisions coming next month will include a lift on the current freeze of health inspection ratings, instituted in February 2018. CMS had done so previously in this category after it implemented a new survey process for long-term care providers, according to the announcement. The concern was that some nursing homes would have been surveyed under the old process while others would be assessed using the new process. “Ending the freeze is critical for consumers,” the announcement said. “In April, they will be able to see the most up-to-date status of a facility’s compliance, which is a very strong reflection of a facility’s ability to improve and protect each resident’s health and safety.”

Further, CMS said it is setting higher thresholds and evidence-based standards for nursing home staffing levels. The agency notes that staffing has the highest impact on quality of care. Currently, those that report seven or more days in a quarter with no registered nurse onsite are automatically dropped to one star, but that threshold for an automatic downgrade will fall to four days.

Officials said they also are changing the quality component of Nursing Home Compare to better identify differences in care among various nursing homes, and incentivize providers to up their game.

Finally, the barrage of changes will also mean the addition of new measures tied to long-stay hospitalizations and emergency room transfers, along with removing some “duplicative and less meaningful” metrics. The agency said it will establish separate quality ratings for short-stay and long-stay residents, and revise rating thresholds to better pinpoint quality variations among SNFs.

Asked to comment on the forthcoming changes, Barbara Gay, LeadingAge VP of public policy communications, said the group supports “transparency and accountability” for the field, but held off on further comment.

“We are reviewing the CMS notice to evaluate the potential impact on our nursing home members. We will continue working with them to help them successfully comply with the new processes,” she said Tuesday.

The American Health Care Association, meanwhile, said it supports the changes to Five Star, but thinks CMS needs to go further. The agency is putting an emphasis on RN staffing related to nurse aides and licensed practical nurses, with new rounding methods. However, it is important to realize that it is not just RNs who play a role in patient-centered care, but also therapists, the group noted.

“Nursing homes across the country have made great strides on the quality measure on Nursing Home Compare, so it is fitting to adjust the scoring thresholds. However, it would be prudent to add measures that do not only include Medicare fee-for-service beneficiaries, unlike the claims-based measures being added,” the AHCA said.