This study was posted in error by CMS, and discovered by KFF Health News and offers a rare insight into the deliberations and considerations used by CMS in constructing Rules of Participation. Due to the controversial nature of a minimum staffing rule, the industry and advocates voiced strong opinions on the findings.
Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say
But a research study the Centers for Medicare & Medicaid Services commissioned to identify the appropriate level of staffing made no specific recommendations and analyzed only staffing levels lower than what the previous major federal evaluation had considered best, according to a copy of the study reviewed Monday by KFF Health News.
Instead, the new study said there was no single staffing level that would guarantee quality care, although the report estimated that higher staffing levels would lead to fewer hospitalizations and emergency room visits, faster care, and fewer failures to provide care.
Patient advocates said the report was the latest sign that the administration would fall short of its pledge to establish robust staffing levels to protect the 1.2 million Americans in skilled nursing facilities. Already, the administration is six months behind its self-imposed deadline of February to propose new rules. Those proposals, which have not been released, have been under evaluation since May by the Office of Management and Budget. The study, dated June 2023, has not been formally released either, but a copy was posted on the CMS website. It was taken down shortly after KFF Health News published this article.
Rau, Jordan. “Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say.” KFF Health News, 29 Aug. 2023, kffhealthnews.org/news/article/cms-study-nursing-home-staffing-levels/.
Providers Bracing for CMS Release of Federal Nursing Home Staffing Mandate at ‘Any Time’
Observers noted early Wednesday that the Office of Management and Budget, which has been reviewing a proposal by the Centers for Medicare & Medicaid Services since May, had canceled planned meetings with stakeholders that were to be held the first two weeks of September. That came on the heels of the accidental online posting Tuesday of a CMS study commissioned to inform the agency’s proposal.
“CMS is in a tough spot. At the end of the day, they have a report that doesn’t support where they want to go,” a long-time Washington policy staffer told McKnight’s on background. The study gave the nursing home sector and consumer advocates their first solid insights to possible CMS strategies.
— McKnight’s Long-Term Care News, August 31, 2023
At the Open Door Forum hosted by the Centers for Medicare & Medicaid Services (CMS) Thursday, officials declined to field questions related to the potential federal minimum staffing mandate for nursing homes even as the proposal has progressed to the next stage.
“We know that many of you may have questions about the forthcoming minimum nursing home staffing standards,” Jill Darling from the CMS Office of Communications, said during the forum. “CMS is committed to improving safety and quality of care for nursing home residents and looks forward to sharing the proposal with you soon.”
— Skilled Nursing News, August 31, 2023
CMS Vows to Move Forward with Staffing Proposal ‘Soon’ Despite ‘Inconclusive’ Research
Federal officials vowed Tuesday night to issue a nursing home staffing requirement “soon,” despite the premature publication of a federal study that appears to support skilled providers’ objections regarding the feasibility of such a measure.
The accidental online posting Tuesday afternoon of the study, conducted by Abt Associates on behalf of the Centers for Medicare & Medicaid Services, at first seemed to undercut a 18-month-old White House plan to institute an hourly direct care minimum at 15,000-plus nursing homes nationwide.
Researchers made no recommendations in the report but said there was “no single staffing level that would guarantee quality care.” Jonathan Blum, principal deputy administrator and chief operating officer at CMS confirmed to McKnight’s in an email Tuesday night that a “draft” of the study was posted in error. But he added that, despite immediate reaction to the study results, CMS remains committed to “holding nursing homes accountable for protecting the health and safety of all residents, and adequate staffing is critical to this effort.”
— McKnight’s Long-Term Care News, August 30, 2023
Leaked CMS Study Calls Into Question Basis For Federal Staffing Minimums In Nursing Homes
“This report confirms what we’ve been saying for more than a year – that an arbitrary staffing mandate is not feasible and will not equate to higher quality care,” said Mark Parkinson, president and CEO of the American Health Care Association (AHCA). “There needs to be a comprehensive approach to staffing beyond numbers, acknowledging that each resident and facility is unique. We all want to increase the nursing home workforce, but instead of blanket requirements during a historic labor shortage, we need resources and policies that will help recruit and retain more caregivers.”
According to KFF Health News, the study was commissioned by CMS to identify the appropriate staffing levels, but made no specific recommendations and ultimately found there was “no obvious plateau at which quality and safety are maximized or ‘cliff’ below which quality and safety steeply decline.” Researchers also wrote that, “Recent literature underscores the relationship between nursing home staffing and quality outcomes…However, it does not provide a clear evidence basis for setting a minimum staffing level.”
— American Health Care Association, August 30, 2023
Industry Leaders Question Leaked CMS’ Staffing Study Data, Worry About Shortages
Industry stakeholders doubted the reliability of the study conducted by Abt Associates.
“Abt Associates sourced data from several SNF domains in their analysis,” Marc Zimmet, CEO of Zimmet Healthcare Services, told Skilled Nursing News. “These source documents are flawed, outdated, inconsistent, and inaccurate to begin with. When cross-contextualized, outcomes are effectively arbitrary.”
— Skilled Nursing News, August 30, 2023
CMS Study Undercuts Potential Nursing Home Minimum Staffing Mandate
The study indicated that no solitary staffing measure could ensure high-quality care – a stance which many leaders in the skilled nursing industry, mired with a staffing crisis, have long endorsed. “Recent literature underscores the relationship between nursing home staffing and quality outcomes, such as reduced pressure ulcers, emergency department visits, rehospitalizations, and outbreaks and deaths related to COVID-19,” researchers wrote. “However, it does not provide a clear evidence basis for setting a minimum staffing level.”
— Skilled Nursing News, August 29, 2023
