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No Rest for the Weary: Check Out These Latest CMS Developments

Published on Tue Jul 31, 2012

Make sure you keep on top of these important actions.

Nursing home compare website

CMS has gone live with its planned changes to the Nursing Home Compare website (www.medicare.gov/nhcompare). The redesigned site made its debut on July 19, 2012. Updates to Nursing Home Compare include:

  • Narratives that detail specific findings from inspections of nursing facilities;
  • Two new measures that report a nursing home's use of antipsychotic medications;
  • Updated data from quality measures previously available on the site.

CMS notes that there were more than 500,000 visits to the Nursing Home Compare website in the first half of 2012.

LTC Requirement Review Project

CMS' clinical standard group is working on a project to overhaul the long-term care requirements "to ensure that they are current, effective and supportive of efforts to improve the quality of care provided to the vulnerable nursing home population," said Kadie Thomas, health insurance specialist, CMS' Office of Clinical Standards and Quality, during the July 12, 2012 SNF Open Door Forum.

"The requirements for long term care facilities have had some revisions since their initial publication, but despite the significant changes in the industry, there has not been any comprehensive review since then," she explained. "We are only looking at Subpart B requirements. So anything to do with payment and/or statute-related stuff is out of the purview of this project."

Thus far, they are looking at several "big ticket items" including:

  • Reducing the burden of LTC regulations on providers;
  • Ensuring that the regulations are geared towards patient-centered care;
  • Keeping LTC regulations focused on quality improvement; and
  • Making sure the regulations are up-to-date and organized appropriately.

"We've begun internally to talk to other folks within CMS, and we've started our external outreach as well, so we can gather as much information as we possibly can before we start this large project," Thomas noted. "We're looking for input on any updates, additions or changes to the current long-term care regulations. Or, you can send things to us that you don't feel need to be changed " things which you feel are working and don't want us to mess with at this point," she explained.

Comments on the LTC Requirement Review Project should be sent to ltccop@cms.hhs.gov. Thomas requested that comments be submitted by August 17, 2012, although this isn't "a hard date" as this is merely the preliminary stage in the process and they are "certainly flexible."

CMS 2012 Nursing Home Action Plan

CMS has posted the 2012 Nursing Home Action Plan on its website at: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandCompliance/NHs.html. "The Action Plan has been published several times since 2004 and it's really the agency's effort to let you know what is going on in the area of nursing homes to improve safety and quality across the agency," explained Kathy Wilson, deputy director of CMS' Division of Nursing Homes, during the SNF Open Door Forum on July 12, 2012.

"It's pretty much what I consider 40 pages of 'one-stop shopping' on what's going on in the nursing home field,"

Wilson said. It is organized into five different objectives as follows:

1. Enhance Consumer Engagement: This section includes information on the Nursing Home Compare website and the Five-Star Quality Rating System.

2. Strengthen Survey Processes, Standards, and Enforcement: This section includes information on the posting of interpretative guidance on advance directives, feeding tubes, and end-of-life care.

3. Promote Quality Improvement: This section includes information on the National Partnership to Improve Dementia Care and Reduce Antipsychotic Drug Use.

4. Create Strategic Approaches through Partnerships: This section includes the agency's communications with the Quality Improvement Organizations (QIOs), State Survey Agencies (SAs), and the national trade and professional associations.

5. Advancing Quality through Innovation and Demonstration: This section includes information on the Nursing Home Value Based Purchasing Demonstration and the Avoidable Hospitalization Demonstration.

All of these sections include background information that will tell you what CMS has already done, what it is currently doing, and what it intends to do in the future that particular area, Wilson explained.

CMS Report to Congress: Plan to Implement a Medicare SNF VBP

On June 15, 2012, CMS published a report on its plans to implement a Value-Based Purchasing Program (VBP) for skilled nursing facilities. The report, which was required by Section 3006 of the Affordable Care Act, discusses the current state of various elements that would be part of a SNF VBP and where the agency will go from there, explained Cassandra Black, senior technical advisor for CMS's Performance-Based Payment Policy Group. These include the following:

  • The agency's current quality measures and process for developing them;
  • Additional quality measures that the agency may want to add;
  • A description of the process for reporting the measures;
  • How payments could potentially be structured;
  • Types of incentive payments;
  • Possible funding sources for the payments; and
  • How the agency would share any information gathered with the public.

The report concludes with a roadmap for implementation of a SNF VBP. The agency will analyze the results of the recent Nursing Home Value Based Purchasing demonstration project, expected to be ready in the fall of 2013 before moving forward with a SNF VBP, Black noted. Copies of the Report to Congress are available at: www.cms.gov/snfpps.

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