Bush Administration to Launch Initiative to 'Ease' Nursing Home Regulation

Chellyse · Sep 9, 2001

For those that already get the Kaiser Daily report this is a repeat. But I wanted to share this and get others opinions. Working in the Nursing Home industry this brings up alot of issues to think about when considering this legislation.

Michele

The Bush administration in the next few weeks will unveil a "nursing home quality initiative" that would ease federal regulation of the industry and would require the government to compile quality of care information about nursing homes and provide that data to the public. According to the New York Times, the plan attempts to move away from what the administration "view as an adversarial approach to enforcement toward a more collaborative one, in which regulators would work with nursing homes to improve care." Centers for Medicare and Medicaid Administrator Thomas Scully said the proposed changes would make inspections of nursing homes, which have lobbied for looser regulations, "more effective and less burdensome." CMS spokesperson Joyce Winslow added that Scully was "very gung-ho on reviewing good nursing homes less often, and bad ones more often." According to the Times, the following is a look at some current nursing home regulations, and how the administration would like to ease or eliminate them:

*Currently nursing homes that receive Medicare or Medicaid funding, which accounts for $39 billion of the industry's overall revenue, "must be inspected once a year on the average, with no more than 15 months between inspections." The administration is suggesting extending the interval between inspections to two years, although it had considered extending the interval to three years.

*Current law calls for a cessation of federal payments to nursing homes "that fail to comply with federal health and safety standards in six months after an inspection." The administration wants Congress to alter the law to allow nursing homes that have made "substantial improvements" and whose "uncorrected violations" did not result in harm to patients to remain in Medicare and Medicaid.

*Finally, the administration wants to reverse a law barring nursing homes with "serious deficiencies" from conducting training programs for nurses' aides.

Quality, Not Quantity

Another provision in the proposal would "devise new measures of the quality of care" to be presented to the public using data reported by nursing homes, including "quality indicators" such as the "number of patients with bed sores, dehydration or significant weight loss," the Times reports. Once government officials "gain confidence in the accuracy" of this information, the "frequency and intensity of inspections" at homes with "a history of good performance" could be reduced, the initiative states. The Times notes that the administration's proposal include a provision to create minimum staffing ratios for nursing homes, as recommended by HHS last year.

An Industry 'Dream Come True'?

Sen. Charles Grassley (R-Iowa), the ranking Republican on the Senate Finance Committee, which oversees Medicare and Medicaid, called reducing inspections for nursing homes "risky," while the Service Employees International Union said the proposal "sounds like the nursing home industry's deregulation dream come true." Grassley said, "The quality of care can change quickly, even for nursing homes that have had good records for extended periods of time. Today's good nursing home might be tomorrow's poor performing facility" given such variables as ownership and administrator changes or an increase in the number of patients with more severe illnesses. Grassley also expressed concern about using the nursing home's own data to develop quality measures. "Self-reported data won't always be objective or reliable," he said. The Times reports that the some of proposed changes -- offered in "confidential" administration documents -- could be made "unilaterally by the administration," while others would require congressional approval (Pear, New York Times, 9/7).

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