Why are U.S. nursing homes eligible for bonuses despite violations? Thirty-six states have eighty-one bonus programs for quality-of-care. These bonuses are taxpayer funded and are approved by the Centers for Medicare and Medicaid Services - the same watchdog that investigates and cites facilities for federal and state regulation violations. Interestingly, a nursing home facility can receive these bonuses despite receiving violations for health and safety standards.
The Des Moines Register reviewed eight bonus programs in seven states. These states do not disqualify a facility from receiving a bonus that is directly related to quality of care if it has received violations for state or federal regulations. A prime example is Grace Living Center in Norman, Oklahoma. This facility received nearly $96,000 in bonuses in the past year and apparently is considered a "five-star" nursing home by the State of Oklahoma. Ironically, federal records show that the facility has been cited for more violations than is the state and national average. Additionally, Medicare ranks the facility as below average on eleven of the nineteen national quality measures. A Eufaula, Oklahoma nursing home scored zero on a scale of one to five for compliance with federal and state regulations, but Oklahoma's Focus on Excellence program awarded the owners with a $50,000 bonus after the program gave the facility "three stars".
The Register also reported that sixteeen of twenty-three Iowa facilities that received major fines last year qualified for bonuses from Iowa's Medicare-Medicaid program. Two of the facilities were on the federal list of the nation's worst nursing homes and a third facility had been threatened with loss of license for substandard care. Iowa officials have since begun revising the program. Today, homes that have caused "actual harm" to residents are to receive smaller bonuses and homes that have put residents in "immediate jeopardy" of death or injury are ineligible for bonuses.
The Iowa Department of Human Services tried to do away with the bonus program last year. They felt that the state should not pay nursing homes additional funds to do what is expected of them. The bonuses will continue at least through June 2009.
The Centers for Medicare and Medicaid said that the law does not require that Medicaid-funded bonuses be linked to quality of care and therefore, the agency cannot require it.
