Nursing home operators hoping for a last-minute change to the new consumer “warning” icon for certain types of abuse citations had received little reason for optimism as of Monday afternoon. The controversial symbol is scheduled to start appearing Wednesday on the consumer-facing Nursing Home Compare website.
Leaders of the two largest U.S. nursing home associations have criticized the icon for a variety of reasons, foremost what they call its misleading messaging. They have noted that an open-palmed hand in a red circle universally signifies “stop” or “do not proceed,” and not proceed cautiously, as Centers for Medicare & Medicaid Services officials have unsuccessfully tried to persuade the provider community.
CMS did not directly answer McKnight’s Long-Term Care News’ inquiries as to whether the icon had been used successfully as a warning symbol in the past, or about how consumers would be directed to ask questions of icon-labeled facilities.
“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,” a CMS spokesperson told McKnight’s in an email.
“CMS will assign the icon for the most severe citations of abuse. 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.”
Providers have said they support efforts to improve transparency but decried the nature of the icon.
“We haven’t heard feedback from CMS yet,” an American Health Care Association spokeswoman told McKnight’s in an email Monday. “We plan to continue sharing our concerns and our members will as well.”
AHCA sent Verma a four-page letter on Oct. 13, protesting the look of the icon and giving other concerns, including the subsequent star-ratings caps that would be triggered. Providers cited for incidents causing actual abuse within the last year will wear the icon, as will those who were cited two or more times over the previous 24 months for incidents where the potential for actual harm was present.
At AHCA’s annual convention last week, the icon was slammed by executives and was the most vigorously questioned topic during a Q&A session with a CMS official.
LeadingAge joined the fray Oct. 14 with a statement criticizing the icon campaign, and the group’s president and CEO Katie Smith Sloan on Monday came out in more detail in a McKnight’s Guest Blog post titled, “Asking too much of an icon.”
“We remain concerned about nursing homes that have consistently provided good care and vital long-term services and supports in their communities being tagged with a shameful icon for what may have been a one-time-only infraction, quickly corrected and reported. There will be nursing homes that have done everything right but will still get this icon, which will stay on their Nursing Home Compare profile for a year or more,” added LeadingAge Senior Vice President for Policy Ruth Katz in an emailed statement Monday.
CMS Administrator Seema Verma announced a five-pillar plan regarding nursing home oversight in April. The icon is an effort to increase transparency, she said in introducing it for the first time on Oct. 7.
“Visual icons are a key transparency resource to alert patients to issues they may want to investigate while making critical decisions about their care,” the CMS spokesman added in their note to McKnight’s. “CMS already successfully utilizes icons on Nursing Home Compare — like the Special Focus Facility icon — and expects to use the abuse icon in a similar way.”