Patient advocates slam Stupak's proposal for nursing home inspections

A new proposal designed to ensure the quality of care at the nation's nursing homes would do just the opposite, a group of patient advocates charged this week.

The Coalition for Quality Care (CQC) says the legislation, introduced last month by Rep. Bart Stupak (D-Mich.), is a lobbyists' gift reflecting "some of the most regrettable expressions of the industry’s persistent efforts" to dilute patient protections at nursing homes.

"The measures proposed in your bill fly in the face of all of the research data that we are aware of relating to enhancing quality of care for nursing home residents, improving the oversight system or using public monies efficiently," Richard Mollot, who heads the CQC's steering committee, wrote in an Aug. 23 letter to Stupak. 

The bill, Mollot added, "is a shameful and Orwellian attempt to undermine our already limited (and overwhelmed) nursing home survey system."

Under Stupak's bill, the Centers for Medicare and Medicaid Services (CMS) would identify high-performing nursing homes — those with a history of few violations — and grant them "top tier" status. These top-tier facilities would then be subject to federal inspection once every three years, rather than annually, as current rules dictate.

The nursing home industry is an enthusiastic supporter of Stupak's proposal. Bruce Yarwood, head of the American Health Care Association, said the changes "would ensure a more efficient use of resources by enhancing CMS’s ability to focus additional time and energy on facilities that are in the greatest need of guidance."

But patient advocates disagree. "The idea of identifying a nebulous 'top tier' of nursing homes for this special lax system of oversight does not in any way ameliorate the enormous risk of potential harm in radically decreasing survey frequency," Mollot wrote. "It is simply counter-intuitive to suggest that a business that is exceeding all standards … would object to an annual survey."

Among CQC's other criticisms: 

• The bill eliminates a requirement that nursing homes submit "statements of deficiencies" — a form of self-policing designed to eliminate trouble spots — replacing it with a new requirement that facilities report "all the positive aspects of care and facility life as well as the aspects of care that may need improvement."

The statement of deficiencies, Mollot said, is designed to identify problems so they can be fixed. "It is not," he wrote to Stupak, "the role of surveyors to provide a 'pat on the back' … for aspects of a facility’s care that is good."

• The proposal doesn't address the lack of funding available to state and federal regulators. 

• It "is largely silent on addressing the problems in those facilities that fail to attain 'top tier' status."

"It is no wonder," Mollot wrote, "that the major nursing home industry lobby associations have both lauded this bill."

Stupak's office did not immediately return a call for comment Thursday.