The Centers for Medicare & Medicaid Services made big headlines last week when it announced that the agency would be sending assistance around the country to help nursing homes either in trouble with or having increased risk of problems with COVID-19.

Among the most surprised were the groups supposed to deliver that assistance — Quality Improvement Organizations — the leader of their umbrella organization told McKnight’s on Tuesday. 

While QIOs and other stakeholders were generally informed something was afoot in the week leading up to CMS’s announcement, both they and the major provider organizations were caught off-guard by the agency’s declaration that expansive help would be provided, said Alison Teitlelbaum, executive director of The American Health Quality Association, which represents QIOs.

“It’s horrible because we want to give broad, sweeping support,” Titelbaum said. “They made it sound like the support QIOs will be providing is much more substantial than what’s actually going to be coming. That was disappointing. We definitely didn’t know they would be putting out a release about it.”

The release also noted that an enhanced survey process would focus on infection control practices at facilities in hotspot areas so that authorities at all levels could leverage “all available resources” to these facilities.

Titelbaum said she is glad QIOs are being involved but is most concerned that the administration has committed “only” $13 million over four years to the effort. On average, that’s equal to less than $65,000 per state, per year — which is less than a single full-time equivalent employee, she explained.

“Because of that low level of resourcing, only a select group of nursing homes will be able to receive assistance,” she said. “This broad, sweeping national assistance to nursing homes that it sounds like CMS is promising just isn’t going to be possible.” 

She noted that only 10 counties across four states had been identified as hotspots as of Tuesday. More were expected to be added at an unknown time. Providers can receive assistance in one of three ways: In person, virtually or “essentially just a webinar.”

Challenged facilities targeted

A CMS spokeswoman told McKnight’s on Tuesday that on-site technical assistance will be available to nursing homes that “have well-known infection control challenges” that are revealed by COVID-19 related data submitted to the Centers for Disease Control and Prevention.

The method of assistance will be up to the operators themselves, Titelbaum noted, acknowledging that some might not want more outsiders on campus. In-person support is most expensive, due to the personal protective equipment needed, which is still tough to come by, she added.

She expressed frustration that QIOs “have no idea” how CMS is determining how many hotspots will be identified or how many nursing homes will come into play.

“This certainly doesn’t seem to be a very strategic deployment, and the funding certainly doesn’t allow for it,” she continued. She said that to her knowledge,funding was being diverted from another program that was to start in the spring. “CMS is not making additional funding available.”

The enhanced survey process that was unveiled Friday is tailored to meet the specific concerns of the hotspot areas, the CMS spokeswoman said.  It will include on-site surveys (within three to five days of identification) of facilities identified in hotspot areas with three or more new COVID-19 suspected and confirmed cases since the last COVID-19 reported data, or one confirmed resident case in a facility that previously had no COVID-19 cases. 

QIOs tailor their support for individual nursing homes, giving each a customized approach. Attempting such strategic interventions will be difficult to accomplish by virtual means, compared to in-person, Titelbaum said. QIOs get their assignments directly from CMS.

Providers that are involved can expect calls directly from a QIO, which is considered an “independent, third-party quality improvement means of resource free to the nursing home — and not a government representative,” Titelbaum explained.

In November, QIOs suffered a 70% funding cut, which came after a four-month funding lapse,” Titlebaum recalled. That’s why AHQA currently is supporting HR 7254, the Infection Control and Support Act of 2020, which was introduced with bipartisan support in the House in mid-June.