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The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017, which outlined proposed changes to Chapter 7 of the State Operations Manual (SOM), and invited public comment. As the Center for Medicare Advocacy noted in a previous alert, the proposed changes sought to reverse surveyor guidance issued … Read more

A message from the Center for Medicare Advocacy and the Long Term Care Community Coalition: June 15th is World Elder Abuse Awareness Day. According to the Administration for Community Living (ACL), about five million – one in ten – older adults are abused, neglected, or exploited every year. Elder abuse can take many forms and may … Read more

In their April 2, 2018 letter to CMS Administrator Seema, Republican leaders of the House Energy and Commerce Committee express serious concern about “recent media reports describing horrific instances of abuse, neglect, and patient harm allegedly occurring at SNFs and NFs across the country.”[1]  They focus particular attention on Dr. Jack Michel, an owner of … Read more

Nurse Staffing in Nursing Homes: CMS Transition to Payroll-Based Journal Staffing Data on Nursing Home Compare Will Provide Better Information for the Public Beginning in April 2018, the Centers for Medicare & Medicaid Services (CMS) will begin using Payroll-Based Journal (PBJ) staffing data to determine each facility’s staff rating on Nursing Home Compare. All facilities … Read more

A February 5, 2018 report from the Government Accountability Office (GAO) revealed that thousands of "Critical Incidents" in assisted living facilities occur regularly with little accountability, highlighting the need for federal protections for assisted living residents.  The Long Term Care Community Coalition and the Center for Medicare Advocacy released a joint statement calling for immediate action … Read more

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident Protections Tax Cut Bill Just Got Worse.  Health Care at Risk. Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 … Read more

CMA Alert –  OIG Warns of Abuse in SNFs; Ted Kennedy, Jr. Joins CMA Advisory Board; “Jimmo” Corrective Action Plan

HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Connecticut State Senator Ted Kennedy, Jr. Joins Center for Medicare Advocacy Advisory Board Jimmo Corrective Action Plan Completed HHS OIG Warns of Potential Elder Abuse in Skilled Nursing Facilities Last week, the HHS Office of Inspector General (OIG) issued an Early Alert, warning of … Read more

CMA Alert – Joint Replacement Model Undermines Care;  OTC Hearing Aids Legislation Passed; More

Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point Over-the-Counter (OTC) Hearing Aid Act Signed into Law Severe Harm if ACA Cost-Sharing Payments End Care is Compromised Under CMS’s Comprehensive Care for Joint Replacement (CJR) Model: A Case In Point On a Friday this past March, “Ms. T”, … Read more

Advancing Excellence in America’s Nursing Homes, a voluntary program promoted as an effort to improve quality of care in nursing homes, has ended after a decade.  Unfortunately, the Centers for Medicare & Medicaid Services (CMS) will continue the website (“New name, new logo, same GREAT website!”[1]), which it has funded since 2006, in a new … Read more

In 2014, The New York Times reported that nursing facilities were gaming the Five-Star Quality Rating System on Nursing Home Compare and that “even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data."[1]  The Times reported that nearly two-thirds of 50 facilities on CMS's watch list … Read more

If properly utilized, Electronic Health Records (EHR) could increase the quality of care for Medicare’s beneficiaries and lower program costs. EHRs provide the possibility of easy transfer of information between providers, and better patient access to important information. This can mean that clinicians are apprised of changes in health status, with access to information regarding … Read more

In 2012, the Centers for Medicare & Medicaid Services (CMS) announced expansion of Medicare’s Value-Based Purchasing (VBP) Program for acute care hospitals.  Beginning in Fiscal Year 2015, and as mandated by Congress in the Affordable Care Act,[1] CMS would incorporate a new measure for “Medicare Spending Per Beneficiary.”  CMS suggested this efficiency measure would reward … Read more

By Cynthia Ronzio, Public Health Consultant The British Medical Journal (BMJ) recently published a highly controversial and alarming study that claims that medical errors are the third leading cause of death in the US.[1]  The authors used crude statistics (for example, they do not describe their method of extrapolation nor is there mention of weights, … Read more

Reports that 20% or more of unplanned hospital readmissions are avoidable has led to considerable interest in policymakers in reducing readmissions.[1]  Actively reducing hospital readmissions is seen as a route to lower Medicare spending and improved patient care. The Affordable Care Act (ACA) established a penalty program for preventable readmissions.  Under the Hospital Readmissions Reduction … Read more

A comparison of the long-term care industry in California, Ontario (Canada), England, and Norway evaluates the extent to which ownership of nursing facilities has shifted from the public sector to private for-profit and not-for-profit companies, and how this shift affects the transparency of information and accountability for public reimbursement.[1] While privatization has been a recent … Read more

A December 2015 Health Affairs study of freestanding Skilled Nursing Facilities (SNFs) from 2001 thru 2011 found that registered nurses (RNs) were less likely to work at nursing homes with high concentrations of racial and ethnic minorities.[1] This study reports on significant health disparities for racial and ethnic minority SNF residents. In the Health Affairs … Read more

The federal government’s funding of a value-based purchasing (VBP) demonstration project in the Medicare Advantage (MA) program did not improve quality of care, as measured by the plans’ five-star quality ratings. The findings from this demonstration are the most recent evidence that paying health care providers more to provide better care, or to improve their … Read more

Medicare beneficiaries often need care in a Medicare- participating skilled nursing facility (SNF) after an inpatient hospitalization.  For these patients, hospitals are responsible for identifying skilled nursing facilities within the geographic region that can meet the patient’s medical needs.  Until such a placement is found, the beneficiary will not be responsible for her hospital stay.  … Read more

In September 2006, the nursing home industry announced a voluntary quality improvement campaign – Advancing Excellence in America’s Nursing Homes.[1]  The campaign, now in its ninth year and third phase, describes its mission: “to make nursing homes better places to live, work, and visit.”[2]  The Center for Medicare Advocacy (Center) was skeptical about the campaign … Read more

The Kaiser Family Foundation (KFF) has published a report entitled “Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations.” The report is authored by Center Senior Policy Attorney David Lipschutz, former Center Policy Attorney Andrea Callow (now at Families USA) and Karen Pollitz, MaryBeth Musumeci … Read more

Two-Thirds of Nursing Facilities Nationwide Will See Decline In their Quality Measures; One-Third of Facilities Will See Decline in Their Overall Score As promised in October 2014,[1] the Centers for Medicare & Medicaid Services (CMS) has made significant changes to Nursing Home Compare, effective February 20, 2015.  The changes recalibrate the Quality Measures (QMs), add … Read more

The Centers for Medicare & Medicaid Services (CMS) announced plans to expand its focused surveys on resident assessments and nurse staffing for nursing facilities nationwide (but not in all facilities), beginning in early fiscal year 2015.  Expanded surveys should lead to more accurate reporting of quality measures and staffing data on the federal website Nursing … Read more

Separating Beneficiary Complaint Review Functions from Quality Improvement Functions On May 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the first phase of its restructuring of the QIO functions.  In the first phase, CMS has contracted with Livanta LLC (for geographic areas 1 and 5), located in Annapolis Junction, Maryland, and KePRO … Read more

April 17, 2014 A recent report by the Department of Health and Human Services' Inspector General found that one third-of nursing home residents in a Medicare-nursing home stay suffered an adverse event or other harm in August 2011 and that most of the events were preventable and caused by problems in staffing.[1]  Yet the nursing … Read more

The misuse of antipsychotic drugs by nursing homes has been the subject of Congressional hearings and Government reports for many decades.[1]  More than 300,000 nursing home residents take antipsychotic drugs and, as the Inspector General found, most of the use violates federal law.[2]  With funding from the Commonwealth Fund of New York and in cooperation … Read more

As policymakers in Washington, DC and beyond continue a national discussion about the state of long-term care in the United States, a critical component of the discussion is the quality of care provided in nursing homes across the country. The nursing home industry argues that nursing home quality is improving, pointing to higher ratings on the … Read more

In its most recent report on nursing home payments and quality, February 2013, the Office of Inspector General (OIG), Department of Health and Human Services (HHS) reports that many skilled nursing facilities (SNFs) failed to provide adequate care planning and discharge planning to residents and provided "egregious" care to some residents, yet were paid by … Read more

Two recent cases – one in Georgia and the other in Pennsylvania – enforce nursing home quality of care standards through actions by United States Attorneys.   In neither case had the regulatory agencies cited deficiencies for the significant care problems at the three facilities in question.   In addition, two of the three facilities have high … Read more

According to an analysis by the Center for Medicare Advocacy (the Center) few sanctions are imposed for the poor care provided by nursing facilities identified by the Federal Government as among those providing the poorest quality of care and quality of life to residents – Special Focus Facilities (SFFs).  The Center's analysis documents an enforcement … Read more

As discussed in last week’s Alert, the current Medicare Annual Enrollment Period lasts until December 7th.[1]  During this time period, Medicare beneficiaries can choose a Medicare Advantage (Part C) or Part D plan for 2013.  This Alert discusses Part C and D plan quality ratings for 2013, and special enrollment periods related to these ratings.  … Read more

On April 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 17, which revises and creates new procedures for the review of quality of care concerns[1] by Quality Improvement Organizations (QIOs).[2] Effective May 7, 2012, the new procedures apply to QIO review of the quality of services "among different cases and settings … Read more

Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public, CMS announced on July 19, 2012. The two sites – Hospital Compare and Nursing Home Compare – have been enhanced to make navigation easier by users, and have added important … Read more

This week, the Obama Administration launched a National Alzheimer's Plan to help the more than 5 million Americans with Alzheimer's disease and their 15 million caregivers. Consisting of funding for clinical research, provider education and outreach, data collection, a public awareness campaign, and proposed funding for caregiver support, the plan provides needed investment and vision … Read more

When research conducted a decade ago documented that mortality rates actually increased when employment rates increased, health economists sought to identify the cause.  Focusing on employed workers did not explain the increased mortality rates.  A new analysis by the Center for Retirement Research at Boston College – focused on who was actually dying when employment … Read more

Reducing hospital readmissions is generating lots of confusion.  The rules are complicated.  In addition, some hospitals, facilities, and health care networks have adopted protocols, and have in place some level of procedures for reduction in hospital readmissions in advance of the requirements set forth in the Affordable Care Act (ACA). In general, the Centers for Medicare … Read more

Nursing Facilities Participating in Advancing Excellence Still Among Worst Performers Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country – the Special Focus Facilities (SFFs) – participate in the nursing home industry's voluntary quality improvement campaign, Advancing Excellence in … Read more

Each month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are among the facilities providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three years.   These facilities, called Special Focus Facilities (SFFs), receive special attention from state survey agencies – at least two surveys … Read more

UNITED STATES SENATE SPECIAL COMMITTEE ON AGING OVERPRESCRIBED: THE HUMAN AND TAXPAYERS' COSTS OF ANTIPSYCHOTICS IN NURSING HOMES November 30, 2011 Testimony of Toby S. Edelman Senior Policy Attorney Center for Medicare Advocacy The misuse of antipsychotic drugs as chemical restraints is one of the most common and longstanding, but preventable, practices causing serious harm … Read more

Hospitalists are defined as physicians who are based full-time in acute care hospitals and who provide care to hospitalized patients.  The past decade has witnessed a rapid growth in hospitals' use of hospitalists, who have been shown to lead to reduced lengths of inpatient hospital stays.  A new study, however, finds that decreased inpatient costs … Read more

On April 4, 2011, the Center for Medicare Advocacy (the Center) filed comments on a proposal by the Centers for Medicare & Medicaid Services (CMS) to establish a new condition of Medicare participation (CoP) for certain Medicare service providers.  These providers would be required to give Medicare beneficiaries notice of the right to seek review … Read more

For more than a year, the Center for Medicare Advocacy has been outspoken about the overpayments made to the private insurance plans in the subsection of the Medicare program called "Medicare Advantage." [1]During this same time period, the proponents of Medicare Advantage (MA) have operated what can best be described as a fierce campaign against … Read more

By January 1, 2012, the Secretary of Health and Human Services (the Secretary) must establish a Medicare Shared Savings Program (MSSP) that promotes accountability for a defined patient population, coordinates items and services under traditional Medicare Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service … Read more

This is the seventh in a series of Alerts by Center for Medicare Advocacy regarding the Patient Protection and Affordability Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). This Alert focuses on changes in PPACA that address measuring the quality of care that is received by Medicare … Read more

The Patient Protection and Affordable Care Act of 2010 (PPACA), the health care reform legislation enacted earlier this year, provides a new opportunity to strengthen and improve federal oversight mechanisms for nursing homes. Implementation of new statutory requirements for public reporting of nursing home ownership information and for Ethics and Compliance Programs in all facilities … Read more

President Obama signed into law Pub.L.111-148, the Patient Protection and Affordability Care Act of 2010 (PPACA), on March 23, 2010, and Pub. L. 111-152, the Health Care and Education Reconciliation Act of 2010 (HCERA), on March 30, 2010. These two laws will change both the availability of health insurance and how health care is delivered … Read more

The Center for Medicare Advocacy is pleased that there is renewed interest in the Congress for establishing a coordinated care benefit in the traditional Medicare program. Any health care reform, including Medicare reform, must embrace a coordinated care benefit. The absence of such a benefit has been detrimental to Medicare beneficiaries for too long. In … Read more

Beneficiary Satisfaction Measure is Not Used to It's Fullest Extent Unlike report cards that use clinical measures, The Consumer Assessment of health care Providers and Systems (CAHPS) reports patient ratings of their experience with care.  The CAHPS surveys were designed to provider consumers of health care with more information and to enable the consumer to … Read more

When beneficiaries receive Medicare coverable health care, there is an expectation that the provider will listen to their concerns and assess and provide appropriate medical care. What can beneficiaries do if they believe that the prescribed medical care is inadequate or incorrect in some way? In Medicare, beneficiaries can request a “quality of care review” … Read more

The following is an executive summary. You can also view the full report here and the appendices here in .pdf form. The Center for Medicare Advocacy performed a study entitled Tort Reform and Nursing Homes that deflates the myths that pervade the nursing home industry’s discussion of tort litigation. It found that cases about nursing home … Read more