Most people will agree with the wisdom that if you’re riding a bicycle, it’s not a good idea to be looking backward too much. Otherwise, that brick wall is going to pop up out of nowhere and teach a lesson about keeping an eye on what’s ahead.
The same can be said of politics or running a skilled nursing facility. Dwell on the past too much at your own peril.
Still, I was quickly reminded Wednesday when hearing Seema Verma talk about why so many important long-term care leaders have been longing lately for some of the old days with her. Verma was the administrator at the Centers for Medicare & Medicaid Services under the previous administration. Make no mistake, as the head of the main regulatory agency that oversees and whacks nursing homes, Verma was not necessarily a beloved figure in the halls and offices of long-term care.
But when she spoke as the featured guest at a one-off live broadcast interview Wednesday, she gave providers plenty of fuel for their wistful time machines. They may not really be able to take time back more than the hour that almost everyone in the US will get Saturday night, but Verma got them thinking, for sure.
“When you really kind of go beneath the surface, I think some of the issues and challenges that nursing homes have faced are not something we can put solely on them,” Verma told interviewer Tim Craig, managing director of the LTC 100. “The government itself has a big role to play in this, especially with Medicaid and inadequate funding, inadequate investment.”
She said leaving nursing home operators out of the “Meaningful Use” government largesse that hospitals and physician offices received for medical records development proves her point. Talk about grabbing a bullet point out of the SNF lobbying playbook.
“It’s a great example of [federal officials] didn’t invest here. Think about what they could be doing around quality and surveys and certifications, which is better data. But the federal government didn’t make those investments.”
She said both federal regulators and lawmakers need better education about the day-to-day challenges nursing home operators face. After that eye-opener, you might have thought you saw Mark Parkinson or Katie Smith Sloan holding the cue cards in front of her by the time she got done talking about the survey system.
“Yeah, I think it’s broken,” she said flatly.
She explained that an order to drastically increase infection control surveys near the beginning of the pandemic proves her point. Most nursing homes passed those special surveys, she said — 97%, in fact. But she recounted how COVID-19 still spread and exposed numerous ways infection control could be improved.
“The surveys didn’t necessarily connect. Even if you do well, it doesn’t necessarily mean you have great infection control,” she said.
“My point is we don’t necessarily see a correlation between surveys and penalties and fines, and better quality care,” she observed. “What I found in my time with CMS, is that nursing homes needed something more. A lot of them want to do better. They might not necessarily have the support, the technical assistance, to be able to improve that quality of care.”
The structure of the survey system has to change, she thinks.
“The idea we’re going to go to a nursing home once a year and be able to spend a few days with them and be able to really assess quality is antiquated,” she said. “When we find problems at a facility, it just doesn’t solve a problem to slap a penalty on them and then walk away. There’s got to be an effort: How do we work in partnership to improve quality of care?”
The echoes of provider lobbyists asking for a more collaborative oversight agency that teaches and not just punishes were ringing in my ears.
Using her unique former perch as the top leader at CMS, she also sympathetically confirmed that providers are opposed by strong forces in the labor and consumer advocate movements.
“There’s a very, very strong active lobby that’s very negative about nursing homes,” she explained. “I can tell you that because they visited me several times as well. It’s a couple of emotional stories, and there’s always a few bad apples, right? We all know that. And that’s the case in any industry, not just the SNF industry.
“No matter where you are, there are going to be cases of fraud, cases of lack of quality,” she continued. “But somehow [that reality doesn’t] make it into the headlines, and members of Congress hear it from people who come to visit them. So you have to kind of counter those pieces as well.”
She wasn’t running for any kind of office, or even auditioning for another top job in government again, as far as I could tell. But she earned at least a few votes of confidence Wednesday from providers listening in. That’s a sure bet, no matter what angle you look at it.
James M. Berklan is McKnight’s Executive Editor.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
