Kansas nursing homes are facing a spike in fines and citations that they consider heavy-handed enforcement of federal regulations, industry members said Wednesday.
Nursing home industries brought their concerns to the Legislature’s KanCare oversight committee. They said rising citations and penalties from regulatory enforcement surveys make it difficult to stay in business and provide for patients. An advocate for older adults said she thought enforcement had been lacking.
Since 2012, federal fines levied against nursing homes for non-compliance have skyrocketed — rising 8,877 percent, according to LeadingAge Kansas, a trade organization representing not-for-profit nursing homes. Those rising fines accompany an increasing number of serious citations that can bring an array of penalties down on nursing homes.
“That is millions and millions of dollars that are being sucked directly out of buildings, out of services, out of communities,” said Rachel Monger, vide president of government affairs for LeadingAge.
Monger said the increased fines did not result from a drop in quality at nursing homes and added to significant challenges nursing homes face, like limited resources, a small workforce and a slow Medicaid reimbursements.
“You don’t have to be a health care expert to know that financially crippling a nursing home is not the way to improve quality of care or quality of life for residents,” Monger said.
Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said she thought there were a number of challenges facing nursing homes, but enforcement of safety regulations had been lacking. She said nursing home citations are “routinely under-reported.”
The U.S. Health and Human Services Office of Inspector General found in August the Centers for Medicare and Medicaid Services lacked the procedures to ensure incidents of abuse and neglect were reported. In September, the office found Kansas inspectors didn’t adequately follow up on about half of deficiencies found in nursing homes.
“I’m not sure it’s been a harsh process,” McFatrich said.
Nursing homes have struggled to get reimbursed by KanCare, the state’s privatized Medicaid program, for services they provided to recipients who were not yet approved for coverage. Those applications were backlogged, often for months. As of two weeks ago, 2,799 new applications and 3,361 reviews had been waiting more than 45 days for processing, according to data provided to the oversight committee.
At the height of the backlog, tens of thousands of applications and reviews awaited processing. Monger has said nursing homes providing uncompensated care to residents struggled to make payroll or buy food for residents.
McFatrich said she thought homes struggling financially might not be safe for residents.
“If your mission is to provide quality care to frail older adults then what do you have to do to make that possible and happen?” McFatrich said.
Jerry Ney, president and CEO of Aldersgate Village Retirement Community in Topeka, said his facility was faced with $441,000 in lost revenue and penalties after it self reported missing labs and received a high-level deficiency citation. A ban on admissions stemming from the report lasted three months and cost $411,000 in lost revenue. On top of that, the facility received a $30,000 penalty.
Ney called the rise in penalties a “crisis situation” and the process “punitive.”
Kansas nursing homes also receive an usually high number of “immediate jeopardy” citations, according to data compiled by Wisconsin’s Department of Health Services. Immediate jeopardy citations mean the nursing home’s regulator violation “has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident,” according to the CMS.
Kansas had the fourth-highest rate of immediate jeopardy citations of any state. More than 30 percent of facilities were cited with one of those severe reports.
McFatrich said she thought research or an audit should be done to determine the cause behind the high number of severe citations. But she said those citations are not taken lightly by surveyors.
“It’s not arbitrary,” McFatrich said. “It’s a serious citation, and it goes up the chain of command.”
Codi Therness, commissioner of survey, certification and credentialing, said the Kansas Department for Aging and Disability Services was still struggling to recruit surveyors to look at nursing homes. It’s understaffed by about a third. The state requires that they be registered nurses but does not provide competitive pay, Therness said.
“I think without having that consistent surveyor it’s hard to really improve the quality of the surveyors themselves,” Therness said.
Therness and Monger said they thought the shift in survey approach came from a shift in interpretation of regulations. Therness said new CMS survey processes will also give more latitude to surveyors to use their judgement. This year, she said KDADS had decreased citations.
McFatrich said she was concerned the lack of surveyors meant nursing home shortcomings were going longer without being found.
Rep. Dan Hawkins, a Wichita Republican and chair of the House health committee, said he met with KDADS Sec. Tim Keck and industry representatives. He said Keck committed to creating an improvement workgroup and slowing down the citations and fines. KDADS did not immediately return a request for comment.
Hawkins said he thought KDADS officials may look into further training and improving survey consistency.