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Anthony Cirillo

Special Focus Facilities Receive Damaging Report

By March 26, 2012

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The Center for Medicare Advocacy recently evaluated Special Focus Facilities (SFFs) from the list released by CMS. It concluded that self-reported quality and staffing information from nursing homes categorized as Special Focus Facilities is unreliable and should not be published on Medicare's Nursing Home Compare website.

The Center compared the star ratings for a sample of SFFs, evaluating the ratings for health surveys (independent outside reviews), staffing (self-reported), quality measures (self-reported), and composite ratings. The Center hypothesized that SFFs would report high levels of staffing and high quality measures.

The Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are among the facilities providing the poorest care to their residents. According to the report, SFFs, which have very low health survey results, nevertheless report high staffing levels and high quality measures. The Center refutes the nursing home industry's claim that facilities can effectively regulate themselves.

The Center analyzed the star ratings for each of the three categories of information publicly reported on Nursing Home Compare: health survey results, staffing, and quality measures.

All SFFs had low star ratings on health surveys. However, SFFs reported considerably higher nurse staffing and quality measures, resulting in higher star ratings on those two domains than on the health survey domain.

Most SFFs had one star in health inspections.

All facilities also reported staffing levels that led to the assignment of star ratings considerably higher than those for their health surveys. Thirty-two of 46 facilities (70%) reported staffing levels that led to star ratings of three or more stars. More than half (25 of 46 facilities, 54%) reported staffing levels that led to four- and five-star staffing ratings. Seven of 46 facilities (15%) reported staffing levels that led to three-star staffing ratings. Only 14 of 46 facilities (30%) reported staffing levels that led to one- and two-star ratings in staffing.

Star ratings for quality measures for all SFFs were also considerably higher than health survey ratings. More than half the facilities (27 of 47 facilities, or 57%) reported quality measures that led to star ratings of three or above. More than a third of the facilities (17 of 47 facilities, 36%) reported quality measures that led to four- and five- star ratings. Ten of 47 facilities (21%) reported quality measures that led to three-star ratings. Only 19 of 47 facilities (40%) reported quality measures that led to one- and two-star ratings.

The report concludes that the lack of correlation between survey data and SFFs' self-reported staffing levels and quality measures, combined with research showing that facilities' self-reported staffing data are unreliable, make their self-reported data highly suspect.

As you can see it is a pretty damning report and came with the following recommendations:

  • Staffing and quality measures should not be reported on Nursing Home Compare for any SFFs.
  • No SFF should be given more than one star on their composite scores unless and until it graduates from the SFF program.
  • Pain should not be used as a quality measure for any facility on Nursing Home Compare.
  • Any proposal to revise the federal survey process by reducing public oversight of facilities that self-report high staffing levels and high quality measures should be rejected.
  • The wording is so strong that I almost suspect this agency has some kind of grudge on their shoulder. But I do agree that self-reported measures have to be suspect. People, they're SELF-REPORTED!

    With a move to aging in place and less acute settings, it is only natural that some natural selection take place. I would envision chronic SFFs eventually close as the marketplace demand goes down and consumers become more savvy about shopping for care.

    Reports like this do not help the industry a whole lot. According to the report, the overwhelming majority of SFFs (45 of 47 facilities, or 96%) are owned on a for-profit basis. What baffles me is that I seldom read about the industry's response to the research. And that is particularly baffling when more and more research comes out against for-profit facilities in an industry dominated by them.

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