Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – July 3, 2019

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  1. Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now
  2. Nursing Home “Quality Measures” Do Not Reflect Quality of Nursing Home Care
  3. New Oral Health Advocacy Collaborative Begins

Court Hearing Next Week in Case that Threatens the Affordable Care Act – Act Now

Oral argument in Texas v United States, the lawsuit seeking to dismantle the Affordable Care Act, will be held Tuesday July 9, 2019. At stake in this case is the health care of millions of Americans. The case will affect the entire health care system and every aspect of the Affordable Care Act, not just the much-discussed pre-existing conditions. People at risk of losing protections and benefits include older Americans and Americans currently on employer insurance, not just those who rely on the Affordable Care Act exchanges for coverage.

Families USA and others have developed resources for social media, and are also scheduling events for next week. Here’s information to help you participate:

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Nursing Home “Quality Measures” Do Not Reflect Quality of Nursing Home Care

The federal website for information about nursing homes, Nursing Home Compare,[1] reports information for each Medicare-certified and Medicaid-certified nursing facility in three categories – health inspections, staffing, and quality measures – as well as an overall score that combines the three domains. The health inspections domain reflects the findings of standard (annual) and complaint surveys that are conducted, unannounced, by state survey agencies. The staffing domain reflects staffing “based on payroll and other verifiable and auditable data.”[2] The quality measures (QMs) domain reports primarily resident assessment information, self-reported by nursing facilities.[3]

Unfortunately, the nursing home industry often uses the quality measure domain to mask poor care. When the media describe deficiencies cited at facilities and enforcement actions that the Centers for Medicare & Medicaid Services (CMS) or states are taking against them, facilities often point to their “quality” to counteract the bad press.[4] CMS should not allow nursing homes to mislead consumers about nursing home quality in this way.

In December 2011, the Center showed that Special Focus Facilities – the nursing facilities nationwide that are identified by CMS as among the most poorly performing facilities in the country – nevertheless reported assessment information that gave them four and five stars in the QM domain.[5]  Several years later, The New York Times reported that incomplete and, at that time, largely self-reported information for staffing as well as quality measures enabled facilities to “game” the system and achieve high ratings on Nursing Home Compare.[6]

CMS has apparently gotten the message. Effective April 24, 2019, Nursing Home Compare no longer gives star ratings to Special Focus Facilities in any of the three domains and no longer reports any information about quality measures for Special Focus Facilities.[7] CMS’s implicit recognition of the misinformation contained in quality measures for Special Focus Facilities is a good first step, but CMS could do more to protect all nursing home residents and families:

  1. CMS could improve transparency by relabeling quality measures “resident assessment data” so that facilities cannot cite the domain to falsely assert that they provide high quality care;
  2. CMS could not assign a star rating to the quality measures domain and only factor health inspections and staffing in the overall star rating; and/or
  3. CMS could remove quality measures from Nursing Home Compare

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[1] https://www.medicare.gov/nursinghomecompare/search.html?.
[2] Section 6106 of the Affordable Care Act, 42 U.S.C. §1320a-7j(g).
[3] Twelve of the 17 measures that are used to determine the quality measures ratings are based on resident assessment data; give are based on Medicare claims.  CMS, Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users Guide, p. 11(Apr. 2019), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/usersguide.pdf.
[4] Wentworth Rehab, a Chicago nursing facility, was the only Special Focus Facility in Chicago, but reported on its webpage that it had a four-star quality rating from the Centers for Medicare & Medicaid Services.  The Chicago Tribune pointed out that the four-star rating was for quality measures.  Sam Roe, “Inside Chicago’s worst nursing home: bug bites, bruises and death,” Chicago Tribune (Jun. 14, 2018), http://www.chicagotribune.com/investigations/ct-wentworth-nursing-home-violations-20180403-story.html.
[5] Center for Medicare Advocacy, “Special Focus Facility Study: Nursing Facilities’ Self-Regulation Cannot Replace Independent Surveys” (CMA Alert, Dec. 22, 2011), https://www.medicareadvocacy.org/special-focus-facility-study-nursing-facilities-self-regulation-cannot-replace-independent-surveys/.
[6] Katie Thomas, “Medicare Star Ratings Allow Nursing Homes to Game the System,” The New York Times (Aug. 24, 2014), https://www.nytimes.com/2014/08/25/business/medicare-star-ratings-allow-nursing-homes-to-game-the-system.html?searchResultPosition=2.
[7] CMS, “April 2019 Improvements to Nursing Home Compare and the Five Star Rating System,” QSO-19-08-NH (Mar. 5, 2019), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-08-NH.pdf.

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New Oral Health Advocacy Collaborative Begins

The Center for Medicare Advocacy is pleased to share a new opportunity for advocates working to add a comprehensive oral health benefit to Medicare. The Oral Health Progress Equity Network (OPEN), a national network of individuals and organizations that believe oral health is essential to overall health and wellbeing, is organizing across the country to ensure that fact is widely understood and embraced. OPEN has recently developed a new community opportunity, The Action for Medicare Dental Learning Collaborative (AMDLC). See below for details, and information on how to join.

Led and facilitated by Melissa Burroughs, oral health campaign manager for Families USA, the AMDLC will include regularly scheduled calls to:

  • Share state and national updates on advocacy and developments around adding a dental benefit to Medicare.
  • Provide a facilitated space for advocates to ask questions of one another and strategize for optimal collective impact.
  • Share guidance – from subject-matter experts and peers – on how state and grassroots advocacy organizations can advance the benefit.
  • Identify existing OPEN resources (and suggest new ones needed) that can support these advocacy efforts.

Who should join the AMDLC?

The AMDLC is for OPEN members working or interested in the fields of Medicare benefits expansion; oral and overall health for seniors; advocacy for seniors; and other aspects of oral and overall health that would be improved or otherwise affected by a Medicare dental benefit. While designed with OPEN members in mind, the AMDLC will also be open to new stakeholders who may want to become involved in the Network by joining this community.

How can you join the AMDLC?

If you have a Socious account and would like to join the AMDLC, please:

  •  Log on to Socious
  • Click on “Communities” on the top toolbar
  • Click on “All Target, State, and Work Group Communities”
  • Click on “Network Response Teams”
  • Once you are on that page, scroll down to find the AMDLC, and click on “Request to Join Community”

Those without a Socious account can request one here, and then follow the above instructions once the account is set up.

The first call of the AMDLC will take place on Tuesday, July 9, from 1:00 to 2:00 pm ET. Once you are subscribed to the Socious AMDLC community, you will receive a call invitation. Please reach out to Stacey Chazin at schazin@anohc.org with any questions.

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