31, 2017
The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.
Ms. Seema Verma (right) was sworn in as the 15th Administrator of the Centers for Medicare and Medicaid Services on March 14, 2017
The shift in the Medicare program's penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry's main trade group, has complained that under Obama inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.
"It is critical that we have relief," Mark Parkinson, the group's president, wrote in a letter to then-President-elect Donald Trump in December 2016.
Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.
The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident's death. The guidelines will also probably result in lower fines for many facilities.
The change in policy aligns with Trump's promise to reduce bureaucracy, regulation and government intervention in business.
Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.
"Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide," Goodrich said.
But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.
"They've pretty much emasculated enforcement, which was already weak," said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.
Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.
The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress increased the fines to factor in several years of inflation that had not been accounted for previously.
The new rules have been instituted gradually throughout the year.
In October, CMS discouraged its regional offices from levying fines, even in the most serious health violations, if the error was a "one-time mistake." The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.
A July memo from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.
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