I have seen articles calling the industry’s response to the new CMS rule ‘fearmongering‘ and ‘hype… don’t buy it.’ Shouldn’t I be concerned?
I have also seen both vendors and conference speakers downplay the new final rule, “Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities,” and the changes in regulations that the Centers for Medicare & Medicaid Services (CMS) is rolling out.
The changes in the new rule do just what Evan Shulman, CMS deputy director in the Division of Nursing Homes Survey and Certification Group, recently indicated. Surveyors’ jobs “will include surveying facilities for everything in phase 1 and phase 2 of the final regulation. It will also include new F-tags. If any of you spent time memorizing the 500 F-tags, I’m sorry,” Shulman says.
CMS came out with the proposed rule last year—the first comprehensive change to the regulations since 1991. Yes, that is 25 years without a significant change to the nursing facility regulations. While there have been changes to the survey process in many states with the Quality Indicators Survey (QIS), now there is also a new survey process to be implemented by CMS, concurrent with the new regulations.
Providers are right to be concerned and begin learning everything possible about the 700 plus pages of the rule. And more than anything, providers have an opportunity now to get ahead of it.
Let’s look at the facts. Based on extensive review and thousands of public comments from major associations and other stakeholders, CMS agreed to phase in the new regulations over three years, which is an acknowledgement of how much time will be required to meet the new standard. Think of how much care for elders,nursing centers, residents, Medicare policy, and expectations from elders and families have changed in the past 25 years.
This can be a huge step forward for nursing facilities.
So don’t believe those speakers who say that antibiotic stewardship and infection control, person-centered care, formal Quality Assurance & Performance Improvement (QAPI) programs, training requirements, and the Ethics and Compliance program are no different than what you are already doing. Hospitals have been doing QAPI rounds for years, and these are not like our Quality Assurance and Assessment. The Centers for Disease Control and Prevention crafted the new antibiotic requirements to bring nursing facilities up-to-date with the field.
Person-centered care is far reaching, and takes many changes to address, starting at the time of the care plan. Look at the growth of, and advances in, dementia care. Think about how post-acute care has changed in the past decade and how it continues to evolve.
This can be a huge step forward for nursing facilities, and the associations are correct that it will take time to get there. Phase 1 kicked it off this November, and the new survey process will be addressing many aspects in Phase 2 a year from now when it rolls out.
So, discount those saying that the changes are minimal or overblown. Start now to design programs required by the new regulations, and the evolution of elder care. Quality will improve, and your facility will be ready for the new survey. Given all the organizations I have worked with for 35 years, I am confident we can elevate quality to the level that the new rule requires, if we start now.