House Hearing Focuses on Nursing Home Safety and Quality

September 6, 2018
Policy Snapshot

This week, the House Committee on Energy and Commerce (E&C) Subcommittee on Oversight and Investigations held a hearing entitled “Examining Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes.” The purpose of the hearing was to explore the roles of the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General at the U.S. Department of Health and Human Services (HHS) relating to the management and safety of nursing facilities.

Witnesses for the hearing included Kate Goodrich, MD, Director at the Center for Clinical Standards and Quality and Chief Medical Officer at CMS; Ruth Ann Dorrill, Regional Inspector General for HHS OIG and John Dicken, Director of Health Care at the Government Accountability Office (GAO).

The E&C Subcommittee began conducting oversight of nursing homes after numerous reports described instances of abuse, neglect, and substandard care occurring in skilled nursing facilities (SNFs) and nursing facilities (NFs) across the country but especially considering the aftermath of Hurricane Irma where 12 residents died in Florida. The Subcommittee wanted to ensure the Federal efforts to verify that SNFs and NFs participating in the Medicare and Medicaid programs are meeting the mandatory conditions of participation (CoPs). They also aimed to examine the role of State Survey Agencies play in overseeing the SNFs and NFs, and review HHS OIG’s and GAO’s work evaluating abuse, neglect, and substandard care occurring at SNFs and NFs.

“Resident safety is our top priority in nursing homes that participate in the Medicare and Medicaid programs. We expect every nursing home to keep its residents safe and provide high quality care. CMS remains diligent in its duties to monitor nursing homes participating in Medicare and Medicaid across the country, and we look forward to continuing to work with Congress, states, facilities, residents and other stakeholders to make sure the residents we serve are receiving safe and high-quality health care,” said Kate Goodrich. Dr. Goodrich also noted that many of CMS’ efforts to improve safety and quality have been based on recommendations from the work of the GAO and HHS OIG, “we greatly appreciate their recommendations and ongoing assistance to ensure resident safety and facility compliance.”

A reoccurring topic during the hearing revolved around the CMS payroll-based journal (PBJ) reporting and the new data being collected as a result. Inconsistent staffing levels along with inconsistent reporting of hours is a challenge for CMS. Many lawmakers noted that staff reporting hours may in fact work more hours than being reported. For example, a salaried employee working more than 50 hours a week would only be entered as having worked 40 hours because CMS only takes data that is auditable. Lawmakers noted that if CMS took actual hours they would see that many facilities do in fact have many staff working overtime. The GAO noted that one of the top long-term challenges for CMS is that it receives accurate information from reporting programs such as the PBJ and that CMS uses the data for improvement and enhancements. The OIG is currently investigating the PBJ, its accuracy, and how the data collected can be used to improve care in facilities. That report will be released in the near future.

To view the entire hearing click here.