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The Centers for Medicare & Medicaid Services (CMS) has announced additional oversight activity as well as updated reporting practices for skilled-nursing facilities (SNFs).
The changes — described in the Jan. 18 Quality, Safety, and Oversight memo QSO-23-05-NH, “Updates to the Nursing Home Care Compare website and Five-Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute — include two significant initiatives:
- Antipsychotic use: CMS has initiated a program of targeted audits to assess the accuracy of the diagnosis and coding of schizophrenia of SNF residents. The use of antipsychotic medications among nursing home residents is an indicator of nursing home quality and used in a nursing home’s five-star rating. However, it excludes residents with schizophrenia. CMS notes that residents who are erroneously diagnosed with schizophrenia are at risk of poor care and prescribed inappropriate antipsychotic medications. Under the new policy, when an audit reveals inaccurate coding, that facility’s Five-Star Quality Measure Rating will be downgraded to one star.
- Posting of citations under dispute: CMS plans to increase the transparency of nursing home information by publicly displaying — on the Nursing Home Care Compare website — survey citations that facilities are disputing. Currently, when a facility disputes a survey deficiency, that deficiency is not posted to Nursing Home Care Compare until the dispute process is complete. This process usually takes approximately 60 days; however, some cases can take longer. CMS notes that while the number of actual deficiencies under dispute is small, they can include severe instances, including Immediate Jeopardy citations. If they occur, the health and safety of residents could be at risk for serious injury, serious harm, serious impairment, or death. CMS includes this information to help consumers make more informed choices when it comes to evaluating a facility. While the citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete. This new information will begin appearing on Nursing Home Care Compare on Jan. 25, 2023.
