Long-Term Care Survey Alert

Patients with metastatic prostate cancer now have a new treatment option. The Food & Drug Administration recently approved a prostate cancer vaccine, Provenge (sipuleucel-T), to treat patients with hormonally-resistant metastatic disease with minimal or no symptoms.

Provenge "is designed to induce an immune response against prostatic acid phosphatase (PAP), an antigen expressed in most prostate cancers," according to a PRNewswire release.

Each patient receives an individualized version of the treatment, according to an article on the vaccine in The New York Times (www.nytimes.com/2010/04/30/health/30drug.html). The patient's white blood cells are collected in a way that separates certain immune cells, which are incubated with the protein found in prostate tumors, according to the article. The cells are then "combined with an immune system booster" and delivered to the patient via an infusion three times over a month's time, the article notes.

CMS recently got poor marks from the GAO on its enforcement for Special Focus Facilities. In a recent report, the Government Accountability Office (GAO) says CMS should exert more efforts to improve poorly performing nursing homes, as some states have not adhered to the requirements of CMS's Special Focus Facilities program.

Under the program, Special Focus Facilities are surveyed twice as often as other nursing facilities and may be booted from Medicare and Medicaid after about 18 months if they fail to improve.

The GAO based its report on analysis of CMS data from 2005 through 2009 on SFFs and other homes, as well as interviews with officials in 14 states selected based on the number of SFFs in each state and other factors.

In 2008, eight states failed to conduct twice as many surveys for homes in the program as required, which was a vast improvement from the 26 in 2007. Also, some homes stayed in the program well beyond the 18-month period for improvement.

The GAO did note, however, that while SFFs were in the program, most of them did improve their performance, "but some failed to sustain their improved performance after graduation."

Acknowledging that the Special Focus Facilities program lacks resources, the GAO issued several recommendations to CMS, including:

• helping states design the criteria for selecting SFFs;

• evaluating CMS' regionaloffices and state adherence to program guidance and the program's impact on nursing homes' performance;

• notifying nursing homes that are on the SFF candidate list;

• charging SFFs -- which would require legislation to do -- for the costs of conducting additional surveys.

Resource: Read GAO report number GAO-10-197, entitled "Poorly Performing Nursing Homes: Special Focus Facilities Are Often Improving, but CMS's Program Could Be Strengthened" at www.gao.gov/htext/d10197.html.