Senators Seek to Identify Subpar Nursing Homes

Published in the Woonsocket Call on July 14, 2019

Last month, U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA) succeeded in prodding the Centers for Medicare and Medicaid Services (CMS) to publicly release the April listing of underperforming nursing homes across the nation that require closer regulatory scrutiny but are not receiving any. Before CMS released the listing of candidates to the Special Focus Facility (SFF) program, the federal agency, charged with overseeing the care and quality in nursing homes, had not publicly identified these troubled facilities.

Less than 6 percent (88 facilities) out of more than 15,700 nursing homes nationwide are participants of the SFF program. CMS publicly identifies these facilities to the public. But an additional 2.5 percent (or approximately 400 facilities) qualify as candidates for the program because of having a “persistent record of poor care” but are not selected because of limited resources at CMS, according to a 26-page report, “Families’ and Resident’s Right to Know: Uncovering poor care in America’s Nursing Homes,” released in June 2019 by Pennsylvania’s two U. S. senators.

Nursing homes that are part of the SFF program have 12 to 18 months to correct any deficiencies and have two clean CMS surveys. If a facility fails to meet that target, it is are subject to increased regulatory enforcement, including being dropped from the Medicare and Medicaid programs.

Calls for Transparency

On March 4, 2019, Casey and Toomey wrote to CMS requesting information on its oversight of nursing homes in the SFF program. In that letter, the Senators requested the federal agency to provide the names of the 400 SFF candidates, calling for details about programs operations, scope and overall effectiveness. On May 3, 2019, CMS provided a written response and two weeks later, on May 14, the Senators received the listing of SFF candidates for April 2019. The names of these SFF candidates were not made public until Cassy and Toomey forced the issue by releasing this information in their report on June 5.

In CMS administrator Seema Verna’s May 14 letter to the two senators, Rhode Island-based participants and candidates in the SFF program were identified. They are: Charlesgate Nursing Center (SFF Candidate); Hebert Nursing Home (SFF Candidate); Oak Hill & Rehabilitation Center (SFF); St. Elizabeth Manor East Bay (SFF Candidate); and Tockwotton on the Waterfront (SFF Candidate).

In responding to the senators, Verma said that regardless of whether a nursing home is part of the SFF program, “any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement,” which includes civil money penalties, denial of payment for new admissions or termination from the Medicare and Medicaid programs. Verma also stressed that in addition to her agency’s regulatory oversight, its Nursing Home Compare website has been improved to include “new, more reliable sources for obtaining staffing and resident census data, as well as including more claims-based quality measures.”

“Regardless of participation in the SFF program, any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement remedies, such as civil money penalties, denial of payment f-or new admissions, or termination,” adds Verma.

Casey and Toomey believe that the list of SFF candidates is information that must be publicly available to individuals and families seeking nursing care for their loved ones. For that reason, the Senators have released the April 2019 list of SFF candidates and are continuing to work with CMS to make future lists public.

Through the release of the SFF candidate list and the Senate report, which details preliminary findings from surveys and public information about these candidate facilities, the Senators aim to provide Americans and their families with the transparency and information needed to choose a nursing home that would provide quality care to a loved one.

CMS Inquiry Identifies Issues

Casey and Toomey’s CMS inquiry into the SFF program put the spotlight on several issues. It became apparent to the two senators that a nursing home’s participation in the SFF program was not easily understandable to the public or would-be residents and their families. It became clear that CMS’s Nursing Home Compare, the agency’s online website, was not consistently updated to reflect any changes in the SFF program. “For example, in March 2019, the small icon used to indicate that a facility is an SFF participant was not on the webpage of five of the 17 newly-added SFF participants,” noted the Senate report. Most important, CMS’ website did not identify SFF candidates.

According to the released Senate report, only CMS and the state regulatory agency in which the nursing home is located and the facility itself, had knowledge of who is an SFF candidate. While CMS requires every nursing home to notify residents and its community of its regulatory SFF participant designation, these requirements do not apply to SFF candidates.

Aside from CMS recently updating its Nursing Home Compare webpage to more clearly indicate which nursing homes are SFF participants, it lacks details about the SFF program. There is no information explaining the reason for a facility’s participation in the program, the length of time it has been in the program or whether it has fixed the care issue. Most important, CMS does not include information on facilities that routinely cycle in and out of the SFF program, says the Senate report.

“There are few decisions more serious or life-altering than that of choosing a nursing home. I am pleased that CMS has taken the work that I have done with Senator Toomey seriously and is heeding our call to release the list of nursing facilities that are nominated to the Special Focus Facility program,” said Casey. “Our bipartisan work will ensure that families have all the information at their fingertips when choosing a nursing home. Now we must work in a bipartisan fashion to ensure the SFF program is working properly and that CMS has the funding it needs to improve underperforming nursing homes nationwide,” he says.

Adds, Toomey, “Ensuring that families have all the information they need about a nursing home will improve the quality of care at facilities across the country.”

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Bush Flip Flops on Politically Charged Medicare Statement

Published in Woonsocket Call on August 16, 2015

On July 30, aging advocates celebrated the fiftieth birthday of Medicare, the nation’s second largest social insurance program in the United States. This program provides health care to more than 53.8 million beneficiaries, with total expenditures of $613 billion in 2014.  Three weeks earlier one GOP Presidential candidate was not calling for the celebration of this golden anniversary, but for the dismantling of it.

On Wednesday, July 22, at a New Hampshire town hall meeting, GOP Presidential candidate Jeb Bush suggested that its time to “phase out” Medicare.  This event was sponsored by Americans for prosperity, a conservative group financially backed by the extremely right-wing Koch Brothers, who oppose President Obama’s Affordable Care Act, the expansion of Medicare, minimum wage and anything else endorsed by Democrats and Progressives. . .

Bush Gets Cozy with Koch Brothers

At the town hall meeting, the former Florida Republican Governor called on the left to “join the conversation” of reforming Medicare.  “But they haven’t,” he charges.

GOP Presidential candidate Bush reminded the attending conservatives that over a year ago Rep. Paul Ryan (R-WI) offered his proposal in the 2015 Budget plan to replace the health program with vouchers and to increase the age eligibility from 65 to 67.  After this, television ads began to appear with a Ryan look-alike pushing a senior off a cliff in a wheelchair, he said, quipping “That’s their [liberals] response.”

Bush went on to say, “And I think we need to be vigilant about this and persuade people that our, when your volunteers go door to door, and they talk to people, people understand this. They know, and I think a lot of people recognize that we need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits. But that we need to figure out a way to phase out this program for others and move to a new system that allows them to have something – because they’re not going to have anything.”

The Democratic National Committee (DNC) quickly seized Bush’s politically charged talking points, posting his comments at Americans for Prosperity event on YouTube.  The DNC jumped on the opportunity to send a message out to older Americans and liberal groups that the Florida Republican opposes a very popular domestic program.

One day later, on August 23, Bush worked hard to dodge intense political flack generated by his call for seriously “phasing out Medicare.” He explained that the Democrats and media took his previous comments out of context, he was only trying to reform Medicare to save it.

Medicare is an “actuarially unsound health system,” says Bush, who called for something to be done before skyrocketing costs burden future generations with $50 billion dollars of debt.

Keep the Status Quo

Bush’s campaigning in New Hampshire has revealed what many seasoned Republicans lawmakers know, there can be a swift political backlash to tinkering with the widely popular Medicare program.  A newly released national poll bluntly supports what AARP and other national aging advocacy groups and Democrats clearly know, the American public is quite happy with their Medicare program.

According to “Medicare and Medicaid at 50,” a new Kaiser Family Foundation poll released on last month, a majority of Americans and the vast majority of program beneficiaries view both Medicare positively.   Simply put, respondents had a strong preference for the status quo over major structural changes that would reshape how the programs serve beneficiaries, say researchers in their 27 page report.

The survey finds that a strong majority (70%) say that Medicare should continue to ensure all seniors get the same defined set of benefits. Far fewer (26%) say that the program should be changed to instead guarantee each senior a fixed contribution to the cost of their health insurance – a system known as premium support that has been proposed to address Medicare’s long-term financing challenges.

By a whopping two-to-one margin, majorities of Democrats, Republicans and independents favor keeping Medicare as is rather than changing to a premium support program. Adults under 65 years old are somewhat more likely than seniors to favor premium support (28% compared to 18%), though large majorities in all age groups prefer Medicare’s current structure.

But, despite the public’s lack of support for this change, the survey says that majority (54%) worry that Medicare will not be able to provide the same level of benefits to future enrollees, and two thirds (68%) say that changes are needed to keep Medicare sustainable for the future.

Improved Outlook for Medicare

While Bush, his fellow Republican Presidential Candidates and Republican Congressional Leadership say that Medicare costs are bankrupting the nation, a recently released Medicare Trustee’s 2015 Annual Report states the opposite.  This program will remain solvent until 2030, unchanged from last years analysis, but with an improved long-term outlook from the 2014 report, says the report released in July.   Under this year’s projection, the trust fund will remain solvent 13 years longer than the Trustees projections in 2009, before the passage of the Affordable Care Act.

“Growth in per-Medicare enrollee costs continues to be historically low even as the economy continues to rebound. While this is good news, we cannot be complacent as the number of Medicare beneficiaries continues to grow,” said Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). “That’s why we must continue to transform our health care system into one that delivers better care and spends our dollars in a smarter way for beneficiaries so Medicare can continue to meet the needs of our beneficiaries for the next 50 years and beyond,” he adds.

The Medicare Trustee’s 2015 Annual Report also noted that per-enrollee Medicare spending growth has been low, averaging 1.3 percent over the last five years. In 2014, Medicare expenditures were slightly lower for Part A and Part D, and higher for Part B than previously estimated. Over the next decade, and partially due to the cost-containment provisions in the Affordable Care Act, per-enrollee Medicare spending growth (4.2 percent) is expected to continue to be lower than the overall growth in overall health expenditures (5.1 percent).

Over the years, Republican Congressional Lawmaker efforts have been largely unsuccessful in changing a very popular Medicare program.  As Bush found out during his politicking in the granite state, touching Medicare can have instant negative political consequences.

Once the GOP whittles down its 16 presidential candidates to a chosen standard-bearer to push its conservative agenda in the upcoming 2016 Presidential elections, the party must reexamine its position of scrapping the existing Medicare program.  Recognizing future challenges in the nation’s health care system, AARP throws commonsense ideas into the national debate as to what is the best way of strengthening Medicare.  The Washington, D.C. aging advocacy group calls for lowering prescription costs, improving health care coordination, and cracking down on over-testing, waste and fraud.

As AARP suggests, simple fixes can lower costs, but it also continues health coverage to the program’s current and future beneficiaries.  That’s the way to reform a widely popular domestic program.  By small incremental steps.