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The Centers for Medicare & Medicaid Services (CMS) identifies some of the most poorly performing nursing facilities in the country as Special Focus Facilities (SFFs).  In this Second Report on SFFs, the Center for Medicare Advocacy looks at one of four categories of SFFs – those that “have not improved” – and how they game and manipulate CMS’s Five-Star Quality Rating System and boost their overall scores to two stars by having five stars in the self-reported quality measures domain.

The July 19, 2018 list of SFFs that have not improved includes 33 nursing facilities in 22 states. The Center looked at the federal website Nursing Home Compare to identify how many jeopardy-level and harm-level deficiencies the 33 SFFs had in the current and prior survey cycles (and in 2018), whether any Civil Money Penalties or Denials of Payment for New Admissions were imposed in the prior three years, whether the SFFs lacked mandated RN coverage or had other problems in staffing data, and their quality measure ratings.

The most striking finding is that 13 of the 33 SFFs (39%) that had not improved had five stars in their self-reported quality measures domain, leading to an upward adjustment from one star to two stars for their overall ratings.  Such high scores on quality measures are implausible for SFFs that have not improved.

Although these 33 SFFs were cited with the highest levels of deficiencies (131 jeopardy-level deficiencies and 94 harm-level deficiencies since 2016), Civil Money Penalties (CMPs) were minimal. Although 29 of the 33 SFFs had at least one CMP imposed over the prior three years, total CMPs for these 29 facilities averaged $68,577 per facility per year over the three-year period. With the Trump Administration’s shift from per-day to per-instance CMPs, total CMPs will continue to drastically decline in the future.

The failure to impose meaningful enforcement actions against even the most poorly performing facilities in the country reflects an environment of ever-diminishing oversight and raises serious concerns for the safety and welfare of nursing home residents.

The Center’s full report is available at:

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