The Complicated Meaning Behind CMS’ New Red Icon

In an effort to increase transparency about nursing home abuse and neglect, the Centers for Medicare & Medicaid Services (CMS) has begun alerting consumers of nursing facilities flagged for abuse by using a red Consumer Alert icon in its Nursing Home Compare website and Five Star Quality Rating System. According to CMS, the icon represents “caution – individuals should investigate further” and appears next to the names of facilities that have been cited for:

• Abuse that led to harm of a resident within the past year
• Abuse that could have potentially led to harm of a resident in each of the last two years

The icon is being updated monthly, and nursing homes that have it will have their highest possible health inspection rating capped at two stars and their overall possible rating capped at four stars.

While intended to make it easier for patients and their families to make more informed decision about their healthcare, major health organizations and nonprofits, including the American Healthcare Association (AHCA) and LeadingAge, have raised concerns on whether the icon achieves this goal as intended or is misleading. In a letter to CMS administrator Seema Verma, Mark Parkinson, President and CEO of the ACHA, argues that the look of the icon, rather than symbolizing caution, implies that consumers should avoid the facility altogether, which could potentially “create unnecessary worry and concern among residents and their families and decrease access to care.”

While at the ACHA conference in October, I heard many providers raise similar concerns. Many also pointed out that CMS’ broad definition of abuse could unnecessarily hurt skilled nursing providers that follow protocols perfectly. Here’s one sample scenario:

A nurse takes medication from a resident for personal use. She’s caught, the case is investigated, the medications are returned, the nurse is fired, the staff goes through a mandatory training. Sounds like an unfortunate incident but the nursing home followed a defined protocol and did the right thing. CMS will cite the facility for the incident (rightfully so, it still happened).

Despite the facility doing everything by the book, this citation will result in a red hand icon, but so too will a case in which a resident is harmed due to intentional mistreatment. In both cases, CMS will mark both facilities with the Consumer Alert icon, without communicating the differences between these cases to consumers who are visiting the site. While acknowledging these and other concerns raised by providers, CMS has defended the measure.

What we can ultimately take away from this new change, no matter where your views lie, is that nursing facilities must remain vigilant in maintaining quality. Abuse is one important measure, but there are many others facilities need to pay attention to achieve high quality all around.

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