New Medicolegal Implications for Skilled Nursing Facilities (SNFS) in 2024



The Special Focus Facilities (SFF) program is a program run by the Centers for Medicare and Medicaid Services (CMS) that aims to improve the quality of care in nursing homes. The program targets nursing homes with a history of poor performance and provides them with additional oversight and support to help them improve. As such, there are several medicolegal implications of the SFF program in 2024.

Firstly, the SFF program has the potential to impact the legal liability of nursing homes. By identifying facilities with poor performance and providing them with additional oversight and support, the program aims to improve the quality of care provided to residents. This can reduce the risk of legal action being taken against nursing homes for malpractice, neglect, or abuse. Conversely, nursing homes that are not part of the SFF program and fail to meet the required standards of care may be at greater risk of legal action. Nursing homes that are part of the SFF program are subject to additional oversight and inspections, which can lead to increased scrutiny and regulation. This can be positive in that it helps to ensure that nursing homes provide a high standard of care to their residents. However, it can also increase the burden of compliance for nursing homes, which can be challenging for facilities with limited resources.

The SFF program also has implications for the healthcare workforce. Nursing homes that are part of the program may require additional staff to meet the required standards of care. This can lead to increased demand for qualified healthcare professionals, which can drive up costs and create staffing shortages in other healthcare settings.

While the SFF program has improved the performance of some skilled nursing facilities (SNFs), many have continued to need to meet standards, leading the CMS to announce revisions to the requirements for SFFs. The state now asks states to be much more selective in the staffing ratios and star ratios as part of their selection of SFF facilities, proposing that state agencies select SNFs with lower ratings to ensure SNFs at the lowest performance are selected. From a medicolegal perspective, this means that SNFs must show evidence-based interventions and good-faith efforts to improve the quality of care.

Another change involves deficient surveys. If surveys reflect that SNFs provide care that puts residents in harm, the state agency must now immediately notify CMS. In addition, any standard survey that results in 13 more deficiencies will not prevent an SNF from successful graduation.

For 2024, SNFs will be focused on the increased stringency of the SFF program, and the need to document measurable attempts at the improvement in order to graduate from the SFF program and prevent additional legal liabilities.

Vipul Kella, MD MBA
Emergency Physician | Expert Witness

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