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‘Room for Adjustment’: Former CMS Chief on Countering Staffing Mandate, Public Image of Nursing Homes
Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services (CMS), isn’t happy with the talk on Capitol Hill around nursing homes, saying that it shows a lack of knowledge on the lawmakers’ part, making it incumbent upon sector leaders to engage with lawmakers directly, even inviting them into facilities.
Currently senior vice president and general manager at Oracle Corporation (NYSE: ORCL), Verma said that her previous role of overseeing health plans covering a staggering 140 million lives, managing a formidable budget of $1.3 billion, and offering guidance to around 6,000 employees provided her with invaluable insights into the intricacies of health care policy.
“I get concerned when I hear about some of the rhetoric in Washington around the nursing home industry, because we need to make sure that we have a viable system,” she said during a webinar discussion hosted by Tim Craig, managing Director of LTC 100.
Verma emphasized the importance of consistent education of lawmakers, tackling the negative image associated with nursing homes, and reinforcing the sector’s role in the evolving healthcare landscape.
“I was steeped in health care when I got to the job, [and] I was still learning,” she said. “I learned a lot during Covid when I got to interact with a lot of the skilled nursing facilities. I learned even more when I visited them as well.”
Moreover, the process of educating policymakers and lawmakers is not a “one-and-done” situation, she said.
“You have to continue to grow their knowledge,” she said. “So, maybe you invite them to your nursing home or maybe you go and see them in Washington. But it is a continual process…if you don’t do it, then you’re subject to other special interest groups having more influence than you yourself might have.”
The role of nursing homes in the healthcare agenda
Verma said nursing homes remain indispensable for specific patient populations, particularly the elderly, who have limited alternatives for care.
While the overarching healthcare agenda emphasizes cost efficiency, accessibility, and quality, nursing homes continue to play a vital role in providing specialized care and support to those who need it, she said.
Verma also touched upon the growing emphasis on home care as an alternative to nursing homes. She said the pandemic undoubtedly brought home care into sharper focus, with its potential to provide safe care to many patients.
However, Verma cautioned against overemphasizing the capabilities of home care.
She said that while it can meet the needs of numerous patients, it may not adequately cater to those requiring high-acuity care, such as event monitoring, dialysis, and oncology treatments. In essence, nursing homes will remain vital for these high-acuity cases, necessitating a balanced approach when advocating for alternative care options, she said.
“There’s a lot of work around value based care around diversion…How do we prevent them from going to the hospital?” she said. “How do we prevent them from going to the nursing home? How do we help people stay in their homes as long as possible to avoid a SNF? That being said, there’s still going to be a need for these services.”
Addressing the negative image of nursing homes
Verma urged providers to counteract negative narratives by sharing success stories and positive experiences within the industry. In addition to highlighting these achievements, addressing fundamental issues such as low profit margins and dependence on Medicaid funding is essential, she said.
“There’s always a few bad apples, right?” she said. “We all know that and that’s the case in any industry, right? That’s not just the SNF industry. No matter where you are, there’s going to be cases of fraud. There’s going to be cases of lack of quality. But somehow those stories really do make it into the headlines.”
To foster a more favorable perception, industry stakeholders should provide better insights into the daily challenges faced by nursing homes and underscore their policy concerns. Moreover, she said, making policymakers aware of the industry’s struggles and its undeniable impact on quality of care is a key advocacy strategy.
“A great example of that would be hospitals and doctors offices that got electronic medical records, but [the federal government] did not make that investment in the SNF industry,” she said. “Think about what we could be doing around quality around surveys and certifications, which is better data, but the federal government didn’t make those investments.”
The impact of staffing standards
One of the most significant concerns discussed during the webinar was the impact of staffing standards. Verma recognized the issue’s importance and encouraged providers to actively engage in the policymaking process.
This includes providing comments on the rule and advocating on Capitol Hill. She emphasized the need to move beyond generic form letters in advocacy efforts, instead recommending that providers offer specific, well-reasoned recommendations for rule adjustments. While the upcoming elections may influence the timing and outcome of these standards, there remains a window of opportunity to address concerns related to the staffing mandate.
“I think there’s still a lot of room for adjustment, a lot of room for influence about what’s workable and what’s not,” she said. “And I think there’s a lot of implications for the rest of the industries, right, the health of the ecosystem. Are they going to start doing this to hospitals? Are they going to start going down the line with this?”
Verma acknowledged the inherent limitations in the current survey process for nursing homes. She highlighted the need for a more data-driven approach that goes beyond annual surveys, considering critical factors such as hospital admissions and quality indicators.
“I think it’s broken,” she said. “When Covid first hit, and we knew about the potential for infection control, and the importance of that – one of the first things we did was divert all of the surveys and focus on infection control, and we did that.”
She said that while most of the nursing homes passed, Covid still spread.
“We know that Covid still spread and there were still opportunities there to improve infection control,” she said. “So my point is that surveys didn’t necessarily connect with you. Even though you do well doesn’t necessarily mean you’ve got great infection control.”
Verma also addressed the disparities in Medicaid reimbursement, both at the state and federal levels. It should stand as a priority, requiring close attention and action, she said.
Verma also discussed the transformative potential of value-based care and alternative payment models (APMs) in healthcare. She highlighted the opportunities for nursing homes to participate in APMs effectively.
To succeed in this landscape, providers should focus on improving care quality and patient outcomes, she said. Collaboration with CMS and other stakeholders is critical to identifying areas where nursing homes can actively participate in APMs.
Advocating for the pivotal role of nursing homes in value-based care, particularly their ability to prevent hospital admissions, is paramount.
“There’s got to be an effort to work in partnership to improve quality of care to make sure that the patients that are being served there are done so in an appropriate high quality way,” she said.
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