South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

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.

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McKnights had an interesting article about how nursing home corporations are very profitable despite the downturn in the economy.   Many nursing homes are private corporation and not publicly traded; those private companies seem to be doing extemely well.  For-profit nursing home companies' stock values are holding strong, despite an overall shaky economy, a new Dow Jones report notes. The key has been relatively stable Medicare and Medicaid payments, though there is complaints about a potential adjustment to payment levels for fiscal 2010, report authors note.

Kindred Healthcare, Skilled Healthcare Group, and Sun Healthcare Group have seen their share values fall from 52-week highs. But each also has been holding steady in 2009. The recently signed economic stimulus bill will provide about $87 billion in Medicaid funding, which is helping company values.

Nursing homes may have decreased revenue in the future although that is doubtful considering Democratic control of the Congress.   Many observers are very interested in what the Centers for Medicare & Medicaid Services might do to counterbalance providers being overpiad by $770 million more than anticipated in Medicare payments for nine higher-acuity reimbursement groups that were added in 2006.   Most insiders predict Medicare cuts, or at least a proposed freeze in annual automatic increases.
 

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Newsday ran a story from the Hartford Courant about how states relying on nursing home chains raise concerns about quality of care provided to the residents.

The article states that large, for-profit chains nursing home chains dominate Connecticut's market, according to an analysis of federal data released Sunday by the Hartford Courant. Such facilities have lower staffing levels and higher rates of serious patient-care violations than small chains and independently owned homes, according to the newspaper's review.

"Ownership is certainly a factor in quality of care," Toby Edelman, senior policy attorney with the nonprofit Center for Medicare Advocacy, told the Courant.

He said many of the larger chains have complex organizational structures with multiple layers of management. "They send a lot of money to their corporate offices," he said. "There can be a lot of distance between the owners and the facilities themselves. They're not on the ground."

The Courant looked at two years of inspection and ownership data from the federal Centers for Medicare and Medicaid Services for the more than 240 licensed nursing homes in Connecticut.  Adjusted for size, homes owned by large chains provided, on average, 16 percent fewer registered and licensed nurses than small-chain and independent nursing facilities, according to the data.

The state's large-chain homes had a 30 percent higher rate of causing patients harm or putting them in immediate jeopardy, the Courant determined. For the five large chains in Connecticut, which control about one third of the state's nursing home beds, such serious deficiencies occurred at a 42 percent higher rate than at homes not controlled by large chains.

Information from: The Hartford Courant, http://www.courant.com
 

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