Providers had a mixed response Wednesday afternoon to a new effort to create more public awareness of nursing home ownership, in particular when facilities share a parent organization.
The American Health Care Association bristled at the introduction of two new data tools by the Centers for Medicare & Medicaid Services. One lists affiliated owners on the consumer-oriented Care Compare site, while the other analyzes ratings and other metrics across any portfolio in a comprehensive database.
Care Compare is an easily accessed site that puts a host of new information at consumers’ fingertips. Some provider leaders immediately raised concerns about how well that information might be understood without context. For instance, a search of any ownership group reveals how many Special Focus Facilities or candidates it has, as well as how many facilities have been hit with an “abuse icon.” But the results page does not appear to explain what those designations mean.
“We support transparency and appreciate the Administration’s efforts to assist families in making more informed decisions. However, focusing on ownership does not prove whether a nursing home is committed to its residents,” AHCA said in a statement. “What’s going to improve care is growing our workforce, incentivizing providers to improve on key quality metrics, and investing in our chronically underfunded long term care system.”
AHCA said nursing homes are focused on quality metrics “that will make a meaningful difference in the lives of our residents.” The statement said policymakers should work in tandem with providers on those goals, rather than simply driving forward with more transparency efforts.
CMS began posting nursing home affiliations and the performance measures on Nursing Home Care Compare and data.gov.cms, respectively, on Wednesday, issuing a memo to surveyors about the newly available data at the same time.
Justification, qualified support
The update is being painted as the next phase in a multi-step process to bring increased transparency to the sector, whose owners and investors have been targeted by the Biden Administration since early 2022.
“As part of CMS’s commitment to transparency, our goal is to provide consumers with as much information about nursing homes as possible to support their healthcare decisions,” the agency wrote Wednesday. “Allowing consumers to see information about a nursing home’s affiliated entities directly on Nursing Home Care Compare supports our initiative to promote data transparency and dissemination, and allows consumers and their caregivers to make more informed decisions about their care.”
LeadingAge took a more supportive approach, with one leader calling the move a “step in the right direction.”
“We are happy to see the Centers for Medicare and Medicaid Services moving in the right direction towards increasing transparency of nursing home ownership,” Jodi Eyigor, director of nursing home quality and policy, said in a statement Wednesday afternoon. “LeadingAge and its nonprofit, mission-driven providers value transparency and accountability obligations because they promote nursing home excellence — and because they strengthen our organizations and the communities that we serve.”
Eyigor said in her statement that LeadingAge wanted to learn more details about how the tools will work and how CMS will make the data accessible and user friendly. She touched on that concern in a call with members Wednesday, adding that “different audiences use these two sites in different ways.”
She asked that CMS make certain the information presented is easily understandable for consumer users, who may not be familiar with all of the regulatory and quality measures cited on the performance pages at data.cms.gov.
CMS memo details
CMS said it is posting affiliated entity names and affiliated entity identification numbers for each facility on Nursing Home Care Compare. It defined affiliated entities as groups of nursing homes sharing at least one individual or organizational owner, officer or entity with operational/managerial control.
The ownership data will be pulled from the Provider Enrollment, Chain, and Ownership System, or PECOS, the electronic Medicare enrollment system.
The performance data will include averages of ratings for the overall, inspection, staffing, and quality measure star ratings, staffing measures, quality measures, select enforcement remedies imposed, percent of facilities for-profit and not-for-profit, number of Special Focus Facilities and COVID-19 vaccination rates, CMS said.
While skilled nursing providers have bristled at some transparency changes, consumer advocates have argued that consumers are often unable to identify facilities under the same corporate structure. While the new groupings may allow Care Compare users to more easily reject facilities owned by a company they see as low-quality, it could also allow them better ability to identify those linked with an organization whose reputation they trust.
CMS has set up an email for providers who believe their affiliation information is incorrect.
Changes or updates can be requested at [email protected].
Accuracy and timeliness of the data could be a concern, given that skilled nursing facilities can change owners frequently. As just one example, a Genesis Healthcare-branded building in Southeastern Pennsylvania currently comes up within the new Care Compare verbiage as belonging to HCR ManorCare, although HCR ManorCare went bankrupt and sold most of its buildings to ProMedica and Welltower in 2018, before some of those assets were bought by Genesis earlier this year.
