No Response from CMS on Punishment for Inadequate Nursing Home Staffing

Oregon Senator Ron Wyden, the ranking leader of the Senate Finance Committee, is still awaiting a response to an August 14th letter he sent the head of the Centers for Medicare and Medicaid Services (CMS) demanding answers on how nursing homes would be held accountable for inadequate staffing and for lying about staffing levels. Noting concerns following a July New York Times article that reviewed staffing data discrepancies between the old and new systems, Sen. Wyden gave CMS head Seema Verma until last Friday to answer 5 specific questions. She has yet to respond.

Specifically, Senator Wyden has asked Ms. Verma to provide the following information:

  1. An answer to what CMS is doing to ensure that skilled nursing facilities are submitting correct hours.
  2. A comparison of staffing data using the old “self-report” method vs. the new electronic system (called Payroll-Based Journaling or PBJ).
  3. An answer to how CMS will impose punishment, if any, on nursing homes whose prior self-reported data was exaggerated.
  4. A response to whether or not CMS would be willing to change their staffing quality data to include information about periods of time in which staffing levels were extremely low.
  5. A response to whether CMS would also be willing to use patient and family satisfaction data as part of its quality rating system.


Self-Reported Staffing Higher Than New Electronic System Shows  
Although training on the new system began in 2015, skilled nursing facilities began using the new payroll-based system to report staff hours in July 2016. However, it was only recently that staffing data using the new system was made available to the public. Once this information was uploaded into Nursing Home Compare, news organizations such as the New York Times and Kaiser Health News pounced on the information, quickly running, and subsequently publishing, analyses of staffing data using the old system vs. the new. The New York Times found that 7 out of 10 nursing homes had lower staffing numbers than they had under the self report model.  Kaiser Health News found that for-profit nursing homes had lower staffing ratios than non-profits and that weekend staffing was especially thin.

The concern about discrepancies in the data lie in the way in which staffing was reported in the past. The old system required nursing homes to submit staffing data for the 2 week period prior to an inspection. As if self-reported data wasn’t already an opportunity to submit false data, inspections are rarely a surprise for nursing homes, leading many facilities to “staff up” before inspections. Another concern is the pattern of nursing homes being short staffed on weekends and nights, as well as the number of days nursing homes go without a registered nurse (RN) on site.


Nursing Homes Now Receive 1 Star for Too Few Days with RN
In July, armed with proof that nursing homes had been lying about staffing, CMS implemented a rule that says nursing homes who go 7 or more days in a quarter without an RN on site will automatically receive just 1 star for staffing in Nursing Home Compare.

Currently nursing homes are rated based on quality measures, inspection data, and staffing. While the punishment is a start, Senator Wyden and elder advocates everywhere would like CMS and Seema Verma to answer what else they plan to do to protect nursing home residents. There has been no word as to if or when Ms. Verma will respond.




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