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January 2, 2018

CMS won't fine nursing homes that violate new standards—for now

Daily Briefing

    CMS has released new guidance that pauses certain fines against nursing homes under Medicare.

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    Background on the fines

    According to federal data, CMS since 2013 has cited nearly 6,500 nursing homes for serious violations discovered during inspections required under Medicare and has fined about two-thirds of those facilities. The nursing homes were most commonly cited for bedsores, failing to protect patients from avoidable accidents, mistreatment, and neglect, Kaiser Health News reports.

    According to KHN, CMS can assess fines:

    • For each day nursing homes violate certain standards; or
    • For specific amounts for certain violations.

    CMS also can deny payments for newly admitted patients as a way to fine agencies for certain violations.

    In recent years, the average fine nursing homes have faced was $33,453, though some nursing homes have faced fines of more than $100,000, according to federal records.

    Details of the new guidance

    According to KHN, the new guidance implements an 18-month moratorium on fines levied against nursing homes that violate eight new safety standards. CMS said the agency will use the 18-month moratorium to educate nursing homes about the new standards.

    In addition, CMS said it would not update ratings on the Nursing Home Compare website for one year, though the agency will publish findings from facility surveys that are completed during that time.

    Industry, stakeholders react

    According to KHN, the adjustment was requested by the nursing home industry, which argued that facilities were having trouble complying with all the regulations and facing mounting fines they could not afford.

    Kate Goodrich, director of clinical standards and quality at CMS, said, "Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn't increase the quality of care they provide."

    However, patient advocates criticized the new guidance, which they said could weaken patient safety.

    Toby Edelman, a senior attorney at the Center for Medicare Advocacy, said, "They've pretty much emasculated enforcement, which was already weak" (Rau, Kaiser Health News/New York Times, 12/24; Savransky, The Hill, 12/26; Zimmerman, Becker's Hospital Review, 12/26; CMS guidance, 11/24).

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