Aug. 7, 2001
Mr. Tom Scully
Administrator
The Centers for Medicare and Medicaid Services
200 Independence Ave. SW
Room 314-G
Washington, D.C. 20201
Fax: 202/690-6262
Dear Mr. Scully:
I am disturbed by the comments attributed to you in The Wall Street Journal on Aug. 3, 2001, regarding nursing home enforcement. You were quoted as calling it "nutty" that federally mandated inspections of nursing homes occur every 12 to 15 months and intimated that compliant nursing homes deserve less frequent inspections.
I would find it "nutty" for the federal government to ease up on nursing home enforcement.
First, the idea of reducing the frequency of standard inspections directly contradicts the General Accounting Office's recommendations for eliminating deplorable nursing home conditions. On Sept. 28, 2000, a representative of the General Accounting Office testified before the Special Committee on Aging, which I chaired at the time, saying:
Vigilance by both state and federal officials must be unrelenting to ensure the safety and well-being of the nation's nursing home residents. The performance of oversight can neither be taken for granted nor relaxed, which means that neither HCFA nor the states can afford to lose their current momentum.
The quality of care can change quickly, even for nursing homes that have had good records for extended periods of time. Multiple factors can affect nursing home performance: ownership changes; turnover among administrators or directors or nursing; or a shift in resident acuity levels. Today's good nursing home might be tomorrow's poor performing facility. In addition, inspecting good nursing homes less frequently might reduce their incentives to perform well.
Many nursing homes provide quality care, but too many do not. The General Accounting Office, at my request, since July 1998 has continued to document the shoddy state of resident well-being at thousands of the nation's 17,000 nursing homes that provide care for nearly 1.6 million people. Despite some increased enforcement by the Clinton administration at my urging, the odds are still too high that a significant number of nursing home residents are suffering from malnutrition, dehydration and bone-deep bed sores as a result of neglect and quality of care deficiencies.
Second, the nation's nursing homes accept $39 billion a year of federal tax dollars ? not including state tax dollars ? to care for 1.6 million residents. The taxpayers have a right to know whether their money is buying good care. One means to fulfill that right is by regular, unanticipated inspections of all nursing homes by qualified inspectors. An inspection of just once a year in exchange for receiving tax dollars to perform a service seems like a fair trade to me.
Third, federal law specifically mandates the frequency of nursing home inspections. The law reflects careful consideration by policymakers. It would be inappropriate to try to undermine the law through agency policy directives to states or other means.
Some health care providers may have legitimate complaints about burdensome government regulations, but it is important to remember that many regulations are in place to protect both patients and taxpayers. If we are to ease regulations, we have to ensure that such action will not compromise health care quality nor increase the vulnerability of tax dollars to fraud. It's very important, therefore, to include all relevant stakeholders, including patient advocates, in your discussions.
I request that you and your administration colleagues keep me informed, in writing, of all efforts to ease administrative burdens and simplify rules and regulations regarding health care. I expect to be informed of changes under consideration and not changes made after the fact.
Lastly, at our meeting prior to your confirmation, you assured me that you would not undermine any of my efforts to improve the quality of care in the nation's nursing homes. I hope your post-confirmation comments quoted in The Wall Street Journal are not indicative of a change in attitude on your part.
Sincerely,
Sen. Chuck Grassley
Ranking Member
Cc:The Honorable Tommy Thompson, Secretary of Health and Human ServicesMs. Janet Rehnquist, Inspector General Designate, Department of Health and Human Services