In a new memo released on Jan. 28, the Centers for Medicare and Medicaid Services (CMS) told state survey agency directors that it is revising the Special Focus Facility (SFF) program to make falls more of a priority than staffing.

“This action is being taken following the Office of Inspector General’s Report, which highlighted the seriousness of nursing home resident falls and the importance of improving fall safety,” the memo said.

The SFF program focuses on nursing homes that have a persistent record of noncompliance leading to poor quality of care. CMS requires these persistently poorest performing facilities selected in each state to be inspected no less than once every six months, and that increasingly severe enforcement actions are taken when warranted.

A leading expert on the SFF program said the move by CMS is substantial.

“CMS’s revised SFF guidance represents a substantive shift from a structural, upstream measure [staffing] to a downstream outcome measure [falls with major injury] as the primary driver of facility selection,” said Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group.

“While this change is framed as a response to the OIG’s findings on fall under-reporting, the OIG analysis did not examine staffing levels or assess staffing–falls correlations. As a result, CMS is elevating an outcome measure that is known to be inconsistently reported, while relegating staffing to a secondary, tie-breaker role rather than a core determinant of risk.”

He added that in this context, the responsibility increasingly falls to providers to recognize that adequate and appropriately qualified staffing remains a foundational driver of safer care and better outcomes, including fall prevention, even when regulatory emphasis is placed downstream on reported harm rather than upstream system capacity.

Read the CMS memo at https://tinyurl.com/y84rema5.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.