CMS Updates Nursing Home CPR Guidance

By on February 23, 2015

HC BLOG_CPROn January 23, 2015, the Centers for Medicare and Medicaid Services (CMS) revised surveyor guidance regarding Cardiopulmonary Resuscitation (CPR) in nursing homes.  The guidance clarifies a facility’s obligation to provide CPR.  CMS requires that nursing home staff maintain current CPR certification through a CPR provider whose training includes hands-on practice and in-person skills assessment.  Online-only certification is not sufficient.  However, the program may have an on-line knowledge component if it also requires an in-person demonstration or skills assessment to obtain certification or recertification.

The revised  surveyor guidance also incorporates CMS’ prohibition against a facility-wide “no CPR” policy because this may prevent implementation of a resident’s advance directives and does not meet the quality standards found in 42 C.F.R. § 483.20(k).  If a resident experiences a cardiac arrest and does not show obvious signs of clinical death, facility staff must provide basic life support, including CPR, prior to the arrival of emergency medical services in accordance with the resident’s advance directives or in the absence of any advance directives or a Do Not Resuscitate Order.   Finally, the guidance reiterates CMS’ requirement that CPR certified staff must be available at all times.

Filed under Centers for Medicare and Medicaid Services, CPR, Nursing Homes

CMS Changes Nursing Home Rating System

By on February 18, 2015

The Centers for Medicare and Medicaid Services (CMS) announced that it will reveal its new Nursing Home Compare 5-Star Quality Rating System to the public on February 20, 2015.   CMS will change its ratings to raise the bar for achieving a high rating in the Quality Measures category.  Thus, ratings will likely fall for many nursing homes even though there has been no change in the quality of care.

CMS is raising the standards for nursing homes to achieve a high rating in the Quality Measures category by increasing the numbers needed to achieve a particular star category.  According to CMS, in 2008 the initial scoring for the Quality Measures rating was set at a distribution that reflected the status quo with the expectation that there would be progress and changes to the quality measures thresholds over time.  When nursing homes have made progress in raising performance standards, CMS resets the distribution to promote further progress.

In addition to raising performance expectations, CMS is making the following changes to the 5-star rating system:

  • Additional Quality Measures:  CMS added two additional quality measures for antipsychotic medication use in nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
  • Staffing Algorithms:  CMS adjusted these measures to more accurately reflect staffing levels.
  • Survey Expansion:  CMS announced a plan for State Survey Agencies to conduct specialized, onsite surveys of a sample of nursing homes in the country to assess the adequacy of resident assessments and the accuracy of information reported to CMS that is used to calculate quality measures.

These changes to the 5-Star Quality Rating System are the third major revision to the Nursing Home Compare website since it was launched in 1998.  CMS says that a fourth change is scheduled for 2016.

Filed under Five-Star Rating System, Medicaid, Medicare, Nursing Homes, Quality Measures