Ex-CMS head Verma: focusing on SNF ownership is a ‘colossal waste of time’, more holistic approach needed to improve quality

As the Centers for Medicare & Medicaid Services continues its efforts to increase transparency about nursing home ownership — and with private equity in particular gaining momentum — the former head of the government agency said called some of the initiatives a “colossal waste of time”.

Instead, former CMS administrator Seema Verma believes a more holistic approach — rather than the punitive approach taken by the administration — is needed to boost quality in the sector.

“We’re not sitting here trying to figure out who owns home health or who owns dialysis facilities or who owns providers. We kind of do this exercise only in nursing homes because we think it’s going to improve the quality of care,” Verma told Skilled Nursing News in an exclusive interview at the Synergy Summit conference in San Diego.

And the Biden administration’s recent laser focus on retirement home ownership may very well discourage investments that could lead to the next “breakthrough innovation in the industry.”

“So vilifying [private equity and other investors] only hurts the industry and the patients we all want to care for,” Verma said during a presentation at the event.

Verma said the federal government could alternatively tie reimbursement and payment more closely to quality.

“Then no matter who owns the facility, no matter who has invested in it, they won’t be able to do well financially, unless you produce better quality. It’s a much better and more direct way to improve quality and it doesn’t matter who owns it, it should be independent,” she told SNN.

While the current administration’s intent to improve quality may be laudable, Verma believes there have been several ‘missed opportunities’ to get to this point – pointing to the expansion of telehealth and process redesign survey like a few.

Timing is everything

The juxtaposition of the proposed federal staffing minimum and the impending $320 million Medicare funding cuts tied to the patient-based payment model (PDPM) remains a headache for many industry players, including Verma. .

More than 400,000 caregivers have left the industry since the start of the pandemic, and although nursing homes have often offered the highest hourly staffing rates in healthcare, the labor shortage does not has not decreased.

“The reality is that the industry needs a broader strategy and if the federal government wants more staff in nursing homes then it needs to improve and invest in efforts to train, recruit and retain staff. nursing homes,” Verma said during the presentation.

Many industry leaders have expressed hope that the 4.6% downward adjustment to SNF payment rates to achieve budget neutrality could take a few years, but current administrator Chiquita Brooks-LaSure told SNN last month that probably won’t happen.

“I would say we have legal obligations and there are rules in what Congress does for us in terms of setting tariffs and that’s the one that’s really needed given the trajectory,” Brooks said. LaSure.

The government agency said it was “imperative” to act quickly once overpayments were identified, in accordance with the proposed rule as published in the Federal Register.

While Verma said she understood the need for the PDPM to be budget neutral, she disagreed that the current administration’s hands were effectively tied on the issue.

And even if CMS had no flexibility on the Medicare cut, the Biden administration has complete control over when and how staffing minimums are offered and implemented.

“I think you kind of have to look at all of this holistically and say, ‘OK, there was a requirement around implementing this new payment program, maybe now is not the time. to make a staff implementation requirement,'” Verma told SNN. .

With crisis comes opportunity

Even though many care home executives believe the industry is at a point of crisis, Verma said during his presentation that with crisis comes opportunity.

This opportunity can be a chance to push for changes that will benefit both nursing home staff and residents.

Verma urged the crowd not to just “attack” regulations that don’t work, but to come to the table with ideas that will improve the industry because “no policy maker wants to support regulations that are going to put nursing homes in jeopardy. bankruptcy”.

Some of the best ideas Verma had in her time as an administrator came from those on the front lines, she told the crowd.

She also offered a few of her own solutions, one being the need to reform a “fundamentally broken” investigative process. It starts with a shift in mindset towards a more efficient and effective monitoring process that delivers results in the form of quality improvements.

“We need to move from a problem-finding system to a problem-solving system because the punitive approach of fines can no longer be the only strategy we resort to,” Verma said during his presentation.

Verma used as an example the nursing home in Kirkland, Washington, which experienced the first outbreak of COVID-19. The facility had a history of infection control issues before the pandemic and had been slapped with significant monetary penalties, but those fines were not the root of the problem.

She said instead of penalties and fines, industry could instead proactively step in and provide best practices and training to help support troubled facilities.

“CMS and States need to invest in modernizing their own processes to create a modern, streamlined oversight system, as we need to be able to monitor their progress and the investigative work done by States and individual investigators to ensure the consistency and quality,” she said during her presentation.

Verma highlighted new innovation surrounding remote patient monitoring that can help support facility-level operations and potentially reduce staffing requirements.

The topic of technology raises another issue with the “inefficiency” of a federal staffing requirement, according to Verma, because such policies cannot contemplate new innovations.

“It just seems like the regulations that have been proposed are really outdated compared to the innovation and technology available today,” Verma told SNN.

She also expressed disappointment with the administration’s decision to withdraw waivers to the expansion of telehealth, arguing that such options should be a permanent feature of the nursing home industry.

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