Nursing homes that serve largely black and Latino patients are more likely to receive a penalty from the CMS' Value-Based Purchasing Program than their peers, according to a new analysis.
The study, published Monday in Health Affairs, is the first to look at how nursing homes that serve minority populations were impacted after the first year of the program, which went into effect in October 2018.
The results show that nursing homes with more than 50% of residents who are black had a nearly 25% higher chance of being penalized under the CMS program compared to facilities with mostly white patients. At the same time, nursing homes with mostly Hispanic or Latino patients had more than twice the odds of being penalized compared to majority-white nursing homes. Under the program, SNFs can see up to a 1.6% bonus in their Medicare Part A payments or up to a 2% cut.
The findings aren't surprising, said Jennifer Gaudet Hefele, lead author of the study and assistant professor in the gerontology department at the University of Massachusetts at Boston.
Previous research shows minority populations suffer from lower quality care at U.S. nursing homes because they are more likely to be treated at facilities that receive the majority of their payment from Medicaid, which has lower reimbursement rates than Medicare and thus straps facilities for resources.
"There is an unfairness built into our system and a lot of it is based on resources," Hefele said. "When you think about quality in general and quality improvement, that takes resources."
In fact, Hefele and her co-authors found that nursing homes with 85% or more of Medicaid-pay patients were 1.5% times more likely to be penalized than nursing homes with less than 50% of their patients paying through Medicaid.
The CMS' Value-Based Purchasing Program currently uses performance on the 30-day all-cause readmission measure to determine nursing homes that will receive penalties or bonuses. The Protecting Access to Medicare Act of 2014 required the CMS to institute the program.
In light of the findings, Hefele said the CMS should reconsider the program, especially for nursing homes that are struggling financially. Many nursing homes are cash strapped, so even a small penalty could be devastating.
"These types of payment policies aren't effective and in fact are hurtful to the providers on the low-end of the spectrum," she said. "Quality goes hand in hand with resources, and it's creating further disadvantage."
Hefele suggests the CMS change the program so it's voluntary; and for nursing homes that don't opt in, they must work with quality improvement organizations that will help them cultivate best practices. State health agencies could also get involved and encourage knowledge sharing across nursing homes.
"Something like that could be helpful to those providers that are already resource-poor," she said.
Hefele and her colleagues plan to conduct further research on the specific penalty amounts nursing homes received.
"There isn't a lot of profit in the nursing homes that are really strapped," she said. "A penalty of $50,000 is a CNA (certified nursing assistant) and a half, or a bonus of $50,000 could pay for more quality improvement or raises. This program does have an impact on providers."
