During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has fined 218 nursing homes more than $17.6 million for the most serious infection control violations that put residents in “immediate jeopardy,” conditions CMS believes are likely to seriously injure or kill them.
According to MedPage Today‘s analysis of the latest federal data, nursing homes with some of the highest penalties since January include the Pennwood Nursing and Rehabilitation Center in Pennsylvania ($983,840), Life Care Center of St. Louis in Missouri ($495,900), Brenham Nursing and Rehabilitation Center in Texas ($427,000), and Riverside Health Care Center in Georgia ($384,199).
Click here for a list of nursing homes that were fined.
“To be forced to reckon with citations and penalties which will draw from funds needed to continue the work of fighting this virus seems to be an inappropriate use of our resources,” said Brooke Ladner, senior vice president of business development at Regency Integrated Health Services, which manages Brenham. The company is appealing the penalty.
“Since the onset of the pandemic, the facility has followed rapidly changing guidelines at the federal, state and local levels to protect its residents and staff,” she added.
More than 91,000 residents and staff of long-term care facilities have died after contracting COVID-19 — about 40% of the total deaths in the U.S., according to a Kaiser Family Foundation analysis. In May through October, weekly COVID-19 cases among residents and staff have increased nearly four-fold in hot spot states, University of Chicago researchers reported earlier this month.
Also since January, CMS cited another 66 nursing homes with infection control violations at the immediate-jeopardy severity level. Officials declined to explain whether this group would also be penalized.
Click here for a table showing nursing home fines by state.
CMS fines facilities based on the number of days the violation continues or on a “per-instance” basis that doesn’t take duration into account. Out of 218 immediate jeopardy violations, 183 received per-diem penalties totaling $16.8 million, averaging $91,987. The remaining 43 received per-instance penalties totaling $727,400, or an average of $16,916. CMS officials would not explain why some nursing homes were placed in either category or why some received both kinds of penalties.
Frustrated by repeated violations of infection control requirements during the pandemic, CMS raised the penalty amounts and announced a crackdown on egregious offenders in August. But the hard-line approach doesn’t seem to have produced the intended results.
Industry representatives argue that fines are not the best way to improve infection control, especially during the COVID-19 pandemic. Advocates for residents and their families, meanwhile, say the fines are an inadequate deterrent.
In addition to policing nursing homes, CMS has taken a softer approach with a new, free infection control training program focusing on COVID-19. However, that strategy has received a lukewarm response. After three months, only 14% of the nation’s 15,400 facilities have completed that training, CMS announced last week.
In a tweet last week, CMS Administrator Seema Verma said “with COVID-19 cases increasing across the country and infection control being a major issue, it’s disappointing that more nursing homes haven’t trained their staff.”
The impact of the penalties has been cushioned by $20 billion in federal funding, free PPE and other supplies, testing machines, as well as technical assistance.
Asked if the agency’s dual roles send a mixed message, Verma said no.
“What we’re telling nursing homes is that we’re going to support you,” Verma said during an exclusive interview with MedPage Today shortly after announcing the immediate jeopardy fines in August.
“But if we find repeat offenses, we have a statutory responsibility” to enforce health and safety regulations, she said, necessitating the increased fines.
“What we want to do is always work with a nursing home to help and we want to support them. But when nursing homes are repetitively non-compliant, that [fine] is one tool in our toolbox and one that we will leverage when appropriate,” Verma said.
Nursing home representatives counter that fines only add to the challenges posed by the pandemic.
“When we focus solely on punishing providers with fines, this does not help the residents, fails to address the underlying issues, and takes away precious resources needed to make improvements,” said David Gifford, chief medical officer at the American Health Care Association, whose members provide care to about one million seniors in some 14,000 facilities.
“Excessive fines run the risk of pushing nursing homes on the financial brink to closure, uprooting the residents, their family members and the staff,” Gifford said. “Nursing homes already face chronic Medicaid underfunding, resulting in less resources for patient care.”
“We do not excuse poor care, nor do we oppose care oversight and regulations,” said Katie Smith Sloan, president and CEO of LeadingAge, representing nonprofit providers of aging services, including nursing homes. “Rather, we advocate for a collaborative approach with CMS and surveyors, with a focus on continuous improvement.”
But collaboration is not what a regulatory agency is supposed to do, said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, who has studied enforcement of federal nursing home requirements. “Congress wanted to have a system of enforcement” when it passed the 1987 Nursing Home Reform Act, she said.
To be an effective deterrent, fines must be greater than the money saved by the violation, Edelman continued, referring to a recommendation of a landmark 1986 Institute of Medicine report that prompted the legislation.
More than three decades later, the institute’s successor, the National Academy of Medicine, has formed a “Committee on the Quality of Care in Nursing Homes.” Its 17 members are meeting this month to develop recommendations addressing nursing home oversight and enforcement, among other issues.