GAO:NURSING HOMES CMS’s Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated

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According to GAO’s estimate, almost 4 percent (580) of the roughly 16,000 nursing homes in the United States could be considered the most poorly performing. These 580 homes overlap somewhat with the 755 SFF Program candidates—the 15 worst homes in each state—and the 136 homes actually selected by states as SFFs. For example, GAO’s estimate includes 40 percent of SFF Program candidates and about half of the active SFFs as of December 2008 and February 2009, respectively. Under GAO’s estimate, however, the most poorly performing homes are distributed unevenly across states, with 8 states having no such homes and 10 others having from 21 to 52 such homes.

GAO found that the most poorly performing nursing homes had notably more deficiencies with the potential for more than minimal harm or higher and more revisits than all other nursing homes. For example, the most poorly performing nursing homes averaged about 56 such deficiencies and 2 revisits, compared to about 20 such deficiencies and less than 1 revisit for all other homes. In addition, the most poorly performing homes tended to be chain affiliated and for-profit and have more beds and residents.

GAO is recommending that the CMS Administrator consider a home’s relative performance nationally when allocating SFFs across states and take actions to refine the SFF methodology to improve the identification of SFFs. CMS generally agreed in principle with our recommendations and said that it would evaluate the effects of adopting them.
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