Nursing homes where a majority of residents are black or Latino were more likely to receive a penalty in the first year of the Value-Based Purchasing Program, according to a new analysis.
The study is the first to look at how nursing homes that serve minority populations were impacted by fines and bonuses that were first doled out last October.
Nursing homes with more than 50% of residents who are black were nearly 25% more likely to be penalized by the Centers for Medicare & Medicaid Services compared to facilities with mostly white patients, according to the findings published July 1.
“The patterns of performance among SNFs serving vulnerable populations underlie concerns about incentive-based approaches to quality improvement,” researchers from UMass reported in Health Affairs. “While SNFS that perform poorly should not be rewarded for delivering lower-quality care, it is concerning that vulnerable populations may be disproportionately affected by penalties.”
About 85% of nursing homes with mostly Hispanic or Latino residents received a penalty, versus about 72% of white-majority homes.
The data also strongly correlated penalties with high-Medicaid populations.
CMS’s own 2018 data showed that only about 27% of all U.S. nursing homes snagged a bonus in Year One, while 73% were penalized based on the same data from 2015 to 2017.
“There is an unfairness built into our system and a lot of it is based on resources,” lead author Jennifer Gaudet Hefele told Modern Healthcare. “When you think about quality in general and quality improvement, that takes resources.”
Added Hefele in the same article: “These types of payment policies aren’t effective and in fact are hurtful to the providers on the low-end of the spectrum. Quality goes hand in hand with resources, and it’s creating further disadvantage.”
While Hefele, an assistant professor of gerontology at UMass Boston, said CMS should reconsider the program or make it optional for financially struggling nursing homes, federal officials seems intent on broadening the approach. Legislation introduced last month sets the stage for as many as 10 value-based purchasing standards for nursing homes beginning in 2022.