CMS using data to better monitor nursing home performance

The Centers for Medicare and Medicaid Services is warning nursing homes that it wants to see better care and outcomes and is using data to track progress.

“Every nursing home resident deserves to retain their basic human dignity and to be treated with respect at all times,” CMS administer Seema Verma cautions. “Just as we’re unleashing innovative strategies and technologies in other areas of CMS, we’re continuously looking for ways to improve our approach to nursing home safety and quality.”

Consequently, CMS is undergoing a comprehensive review of regulations, guidelines, internal structure and processes related to safety and quality in nursing homes. It initially focuses on updating the Nursing Home Compare website that helps consumers select a home, and consumers to identify and report instances of non-compliance in homes.

Verma-Seema-CROP.jpg
Seema Verma, Centers for Medicare and Medicaid Services administrator nominee for U.S. President Donald Trump, speaks during a Senate Finance Committee confirmation hearing in Washington, D.C., U.S., on Thursday, Feb. 16, 2017. Verma, the businesswoman Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. Photographer: Pete Marovich/Bloomberg

To reduce abuse in nursing homes, CMS is looking toward data analytics.

“We’re exploring the possible use of Medicare claims data and associated adverse outcomes or indicators, including the use of artificial intelligence and text mining, to inform our nursing home survey and oversight process, especially for individuals transferred from a nursing home to a hospital,” Verma says. “Data also may be used to identify nursing home workers with a history of abuse.”

CMS further is working with State Survey Agencies (SSA) that oversee nursing homes and are supposed to visit and survey every Medicare and Medicaid nursing home at least annually. But regulators have found wide variation in the diligence of SSAs as they review homes—CMS plans to give them clearer procedures.

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The agency also is collecting staffing data from nursing facilities, based on payroll and other verifiable and auditable data, and will share it with SSAs so they know which nursing homes may have staffing issues and can target their reviews. SSAs also are conducting some inspections after hours or on weekends to assess any staffing problems at those times.

The CMS push for improved nursing home care now is expanding to consumers, families and caregivers via the Nursing Home Compare Web site, which offers a variety of data related to nursing home quality.

This month, the agency added more data on nursing home staffing based on a new payroll-based journal information system, called PBJ, which enables CMS to more accurately track staff levels.

“Adding this data to Nursing Home Compare provides an entirely new and key source of quality information to nursing home residents, their families and caregivers,” Seema says.

Other improvements recently introduced to provide more information to stakeholders include publicizing CMS terminations of agreements with nursing homes exhibiting poor quality—and loss of CMS payments—on the CMS website; and making reports on health and safety deficiencies of nursing homes more readable to enable families to know the scope of deficiencies found during an inspection.

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