CMS seeks to strengthen nursing home transparency

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In a bid to improve nursing home transparency, safety and quality and accountability, the White House has announced new actions to reduce the inappropriate use of antipsychotic medications and to bring greater transparency about nursing home citations to families.

Beginning this month, CMS will conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis. Nursing home residents erroneously diagnosed with schizophrenia are at risk of poor care and prescribed inappropriate antipsychotic medications, CMS said.

Antipsychotic medications are especially dangerous among the nursing home population due to their potential devastating side effects, including death, the agency said.

WHAT'S THE IMPACT?

The action furthers a larger administration goal of improving the accuracy of the quality information that is publicly reported, and of the nursing home Five-Star Rating System. The idea is that the use of antipsychotic medications among nursing home residents is an indicator of nursing home quality. It's used in a nursing home's five-star rating, though it excludes residents with schizophrenia.

If an audit identifies that a facility has a pattern of inaccurately coding residents as having schizophrenia, the facility's Five-Star Quality Measure Rating on the Care Compare site will be negatively impacted. For audits that reveal inaccurate coding, CMS will downgrade the facility's quality measure ratings to one star, which would drop its overall star rating as well. 

CMS will monitor each facility's data to determine whether it has addressed the identified issues. After that, the agency will decide whether any downgrades should be reversed.

Separately, CMS plans to take a new step to increase the transparency of nursing home information by publicly displaying survey citations that facilities are disputing. Currently, when a facility disputes a survey deficiency, that deficiency is not posted to Care Compare until the dispute process is complete. This process usually takes approximately 60 days; however, some cases can take longer.

While the number of actual deficiencies under dispute is relatively small, these deficiencies can include severe instances of noncompliance, such as Immediate Jeopardy citations. This level of citation occurs when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment or death. Displaying this information while it is under dispute can help consumers make better informed choices when it comes to evaluating a facility, said CMS.

This new information will begin appearing on Care Compare on January 25. While the citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete.

THE LARGER TREND

CMS has taken several actions over the years meant to strengthen public reporting and the Five-Star Quality Rating System. They include adding the results of focused infection control surveys to the Care Compare website and Five-Star Quality Rating System; increasing the Quality Measure rating thresholds to incentivize improved quality; and adding measures of staff turnover to inform consumers of the stability of a nursing home's staff, which is linked to the quality of care a nursing home provides.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com