Imposing strict audits of nursing home cost reports and establishing more requirements for ownership changes would allow President Joe Biden’s administration to address persistent accountability and transparency problems that experts say have plagued the industry. 

Those recommendations were among several reform measures proposed by a group of healthcare, policy and industry experts in an article published Thursday in Health Affairs.

The Centers for Medicare & Medicaid Services has been unable to ensure accurate and complete facility ownership data to address chains with persistent quality issues, thanks in part to a lack of audits that would address inaccurate financial reporting and hold problem chains accountable.

The authors believe the federal government should amend cost-report requirements to mandate each nursing home “provide annual consolidated financial reports that include data from operating entities (license holders) and all organizations and entities related by common ownership or control.” 

“We’re trying to think of what really needs to be done right away. It just seems like it needs to be on the top of the priority list,” co-author Charlene Harrington, RN, Ph.D, emeritus professor at the University of California, San Francisco, School of Nursing, told McKnight’s Long-Term Care News. “I’m hoping [the Biden administration] does it right away. It doesn’t really require Congress to put any legislation in place.”

“It’s something that is an easy fix just to make things more transparent,” Harrington explained.

The authors argued that while persistent issues with quality of care at nursing homes has been long-documented, there’s been no true effort to implement stricter oversight on how facilities spend their Medicare and Medicaid payments. 

Harrington’s co-authors include Harvard healthcare policy professor David Grabowski, Ph.D., geriatrician Michael Wasserman, M.D., Altarum’s Anne Montgomery and Terris King, a retired director of minority health at the Centers for Medicare & Medicaid Services. 

The experts also recommended that CMS should promulgate federal regulations specifying minimum criteria for the purchase (or change of ownership) or management of any nursing home. By doing so, they argued it would “prevent individual or corporate owners from purchasing, operating, or managing additional facilities if they have a history of owning or operating other facilities with chronically low staffing and poor-quality care in any state.”

They also called on CMS to establish a prior approval process for changes in ownership or management, the Department of Health and Human Services to create an interagency task force to identify and monitor nursing homes that need more focused attention and the establishment of a combined financial and oversight system to conduct annual joint Medicare and Medicaid audits.

The full recommendations can be found here.