GAO Report on Worst Facilities
GAO released a Study of CMS's Special Focus Facility Program.
What GAO Found:
According to the Government Accountability Office, almost 4 percent (580) of the 16,000 nursing homes in the United States could be considered "the most poorly performing" under CMS's Special Focus Facility program. States currently identify some 755 nursing homes (the 15 worst in each state) as "candidates" for the program, and 136 are actually designated as SFFs. Under GAO's methodology, the report says, the most poorly performing homes are distributed unevenly across states, with 8 states having no homes that actually qualify and 10 others having from 21 to 52.
The most poorly performing homes tended to be chain-affiliated and for-profit and have more beds and residents.
CMS has structured the SFF Program so that every state (except Alaska) has at least one SFF, even though the worst performing homes in each state are not necessarily the worst performing homes in the nation, according to the GAO. To identify the worst homes in the nation, GAO applied CMS's SFF methodology on a nationwide basis and made refinements to the methodology that "strengthened" GAO's estimate.
GAO found that the most poorly performing nursing homes had notably more deficiencies with the potential for more than minimal harm or higher and more revisits than all other nursing homes. For example, the most poorly performing nursing homes averaged about 56 such deficiencies and 2 revisits, compared to about 20 such deficiencies and less than 1 revisit for all other homes.
CMS established the Special Focus Facility Program in 1998. The SFF methodology assigns points to deficiencies cited during standard surveys and complaint investigations, and to revisits conducted to ensure that deficiencies have been corrected. CMS uses its methodology to identify candidates for the program--nursing homes with the 15 worst scores in each state--but the program is limited to 136 homes at a time because of resource constraints.
