Florida Nursing Home Abuse Lawyer – Centers for Medicaid & Medicaid Services Changes Rating System

Providers could see an automatic shift in their federal star ratings all because of several new changes to the system, including the controversial addition of a warning icon next to certain cited facilities and the removal of two pain quality measures.

The Centers for Medicaid & Medicaid Services announced last week that it is removing from the Nursing Home Compare website and the Five-Star Quality Rating System quality measures related to residents’ reported experiences with pain. 

The measures being removed are: percentage of short-stay residents who report moderate to severe pain and percentage of long-stay residents who report moderate to severe pain. 

CMS also announced last week that it will soon place a bright red “stop” hand icon next to facilities that have received recent abuse, neglect or exploitation citations. 

Nursing homes with an alert icon will have their highest-possible health inspection rating capped at two stars and their overall possible rating capped at four stars, said Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of curriculum development for the American Association of Post-Acute Care Nursing.

Stewart added that providers could see a shift under the quality measures domain following the removal of the two measures. She strongly suggested that providers, especially those cited for abuse within the last 24 months, check their Five-Star Ratings once the changes go into effect on Oct. 23. 

She joined other providers in calling for CMS to address inconsistencies with surveys between states and to consider adding other determinants of quality instead of pursuing the “alert” icon, which some have pointed out actually conveys a much more foreboding “Do not proceed” message.

“Abuse is never OK,” Stewart said. “Abuse and neglect to the resident is never to be tolerated. We all agree on that, but the real issue is how surveyors determine whether abuse and neglect has occurred. We’re all one incident from potentially getting cited for abuse and then this icon being put up there.”

Quality measure thresholds will also be increasing under CMS’ latest efforts. The change could result in nursing homes seeing a decline in their ratings until improvements are made. 

CMS will begin increasing quality measure thresholds by 50% of the average rate of improvement in QM score, and will do this every six months. The agency hopes the change will “drive continuous quality improvement by raising standards for all facilities to achieve certain ratings,” documents stated. 

“As CMS changes the QM thresholds, some nursing homes will see a decline in their rating in these areas until they make further improvements. Also, because the QM ratings are also used as part of the overall rating, some nursing homes will see a decline in their overall five star rating,” CMS wrote.

Nursing home negligence can present itself as physical abuse, financial abuse, emotional abuse or any other types of abuse or neglect. Every year an estimated 2.5 million Americans are victims of elderly abuse through negligent nursing home care and assisted living facility care.  

Due to the fact that nursing home and assisted living facility residents are a very vulnerable population, family members and friends rely upon the chosen facility to ensure that their loved one receives the high quality of care and dignity they are entitled. Unfortunately, nursing homes and assisted living facilities don’t always do this. Nursing home negligence embodies anything that fails to protect residents from health and safety hazards. Negligence can result in severe injuries such as broken bones, bedsores or pressure ulcers, dehydration, malnutrition, and other medical conditions which cause harm and even death.

Our Tampa Bay Nursing Home Abuse Lawyers at Whittel & Melton will fight to recover all that you and your loved one deserve. We have extensive experience in nursing home negligence matters, and we are thorough in our investigations of each individual case. We know that no two cases are exactly alike, which is why we prepare each case for either settlement or trial in order to obtain financial compensation for injuries, medical expenses, and pain and suffering. Our ultimate goal is to help victims and their families hold these negligent facilities accountable.

At Whittel & Melton, we will fight to recover every benefit that you deserve. Sometimes the only way a positive outcome can be achieved is by going to trial. However, that does not mean that we cannot obtain a favorable settlements outside of the courtroom, which can make the experience less stressful. We will work with you and your family to find the best approach to your individual case.

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