A 4 minute read
April 29, 2019

We are only four months into 2019, but it’s been a busy time for the Centers of Medicare and Medicaid Services (CMS), particularly when it comes to nursing home regulations. Let’s take a look at some of their latest updates, which will impact long-term care across the U.S.

1. April 2019: Nursing home health inspection five-star ratings are back

Back in 2008, CMS created a “Five Star Quality Rating System” to rate nursing homes based on health inspections, staffing, and quality measures (QMs). This system was placed on hold in February 2018, when CMS instituted a temporary “freeze,” where they held each nursing home facility’s health inspection rating constant for approximately one year. Now, the freeze has been lifted, and CMS is planning on resuming the use of this scoring system – with inspections occurring on or after November 28, 2017 included in each facility’s star rating. The “unfreeze” comes with a few improvements in the QM and staffing domains:

  • Staffing improvements: The threshold for the "number of days without a registered nurse (RN) onsite," which triggers an automatic downgrade to one star will be reduced from seven to four days.
  • Quality Measure (QM) improvements:
    • Generally, there are two groups of residents in nursing homes: short- and long-stay residents. In order to help consumers better understand the level of quality each nursing home provides to these two groups, CMS is now creating separate short-stay and long-stay QM ratings, in addition to the overall QM rating.
    • CMS is also implementing a process to incentivize continuous quality improvement by taking the average rate of improvement in QM scores and increasing it by 50 percent. For example, if there is an average rate of improvement of 2 percent, the QM threshold would be raised 1 percent.

As these changes go into effect, nursing homes may see a decline in their rating until they make further improvements. It’s important to note that a decline in a nursing home’s five-star rating does not necessarily represent a sudden decline in quality, but rather an area of improvement based on these new rating thresholds.

2. March 2019: Continuing to crack down on unnecessary antipsychotic prescriptions in nursing homes

CMS is dedicated to reducing the number of residents that are prescribed unnecessary antipsychotic medications. In 2011, 23.9 percent of long-stay nursing home residents were receiving an antipsychotic medication. In an effort to reduce this number, CMS created The National Partnership to Improve Dementia Care in Nursing Homes, which requires nursing homes to prove a valid, clinical indication for the antipsychotic prescription and a systematic process to evaluate each individual’s need. Since then, there was a decrease of 38.9 percent to a national prevalence of 14.6 percent in 2018. However, there are still about 1,500 facilities with high rates of antipsychotic prescriptions.

CMS Regional Offices (R0s) will be closely monitoring those facilities’ progress this year, with a new goal to reduce the prevalence of antipsychotic use in long-stay nursing homes by 15 percent. Noncompliant facilities may receive a per-day Civil Money Penalty (CMP).

3. March 2019: Revised guidelines that determine immediate jeopardy (IJ)

Immediate jeopardy is a situation where a person has suffered, or is likely to suffer, serious harm, injury, impairment, or death. Nursing home residents are some of the most vulnerable people in our society, often possessing high acuity and multiple co-morbidities. Because these vulnerabilities may make residents more susceptible to serious harm, surveyors must consider the vulnerabilities of the resident at risk on an individual basis when determining whether noncompliance has resulted in immediate jeopardy.

For instance, if a resident frequently has bruises after a nurse or visiting family member leaves the room, the center may be on notice of potential IJ abuse and be required to act on it. On the other hand, if a certain family member who normally treats the resident with love suddenly decides to push the resident in anger, the center is unlikely to be cited because the staff had no reason to increase supervision.

To help nursing facilities determine if a situation has the key components of immediate jeopardy, CMS recently created a template to help surveyors during their documentation process.

What these updates mean for US nursing homes

Healthcare is increasingly moving toward consumerism, and long-term care facilities are no exception. Children want to place their elderly parents in cost-effective, convenient, and – most importantly – safe nursing homes, and these new regulations will make that search easier. Even more importantly, these regulations will help CMS set a new standard for health and safety at these long-term care facilities.

Learn More

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Tory Waldron

Tory Waldron is a communications professional with a lifelong passion for writing and editing. Before joining Definitive Healthcare, she spent three years at a PR agency working with various B2B ...

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