The ranking member of the U.S. Senate Committee on Finance is demanding answers on how the federal government plans to better hold nursing homes accountable for staffing decisions.
Sen. Ron Wyden (D-OR) sent a sharply worded letter to Centers for Medicare & Medicaid Services Administrator Seema Verma on Tuesday. His concerns stemmed from the “upsetting” front-page New York Times article, published in July, which concluded that “payroll records provide the strongest evidence that, over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels.”
Wyden noted in his letter that the healthcare system has evolved greatly in the decade since the rating system was established. He believes the federal government must do the same with how it measures nursing home quality.
“Ten years after pushing CMS to increase nursing home transparency, I am concerned that seniors and their families may not have accurate and complete information about the quality of nursing homes available to choose from,” Wyden wrote.
“It’s clear the manner by which CMS measures nursing home quality needs updating,” he added.
The senator also expressed concerns about info unearthed from Payroll-Based Journaling collections. Mainly that, 7 in 10 homes were found to have lower staffing using the new methods, with a 12% average decrease. “If true, it is concerning that seniors and their families have been receiving inaccurate or erroneous information about the staffing levels provided by a SNF.”
In late July, David Gifford, M.D., the American Health Care Association’s vice president of Quality & Regulatory Affairs, noted that the lower rankings don’t mean that staffing has declined.
“While staffing is one of many important metrics in quality care, what really matters are health outcomes and customer satisfaction,” he said in a statement at the time. “The changes to the CMS Five-Star system doesn’t mean that staffing or quality has actually changed in the past several months.”
Wyden gave Verma an Aug. 24 due date to provide answers to the following questions: 1) What are the safeguards CMS has in place to ensure SNFs provide accurate information? 2) What is the difference in staffing levels between self-reported and payroll data methodologies? 3) What will the agency do if it finds self-reported data to be inaccurate? 4) Would CMS update staffing quality measures to account for inappropriate fluctuations in staffing? and 5) Would CMS consider measuring patient and family staff satisfaction as part of Five Star?
The last appears to be a nod to providers, who have asked in the past for satisfaction feedback to be included in ratings calculations.