Special Focus Facility Scoring Methodology Published

VHCA (10/16/2008)

The Centers for Medicare & Medicaid Services (CMS) Special Focus Facility (SFF) program has been in existence since 1998 as part of the agency’s Nursing Home Quality Initiative.  The SFF program was initiated to address the challenges posed by a number of nursing facilities that, according to CMS, consistently provided poor quality of care, but periodically instituted enough improvement in the presenting problems that they would pass one survey only to fail the next (for many of the same problems as before).  CMS posed that such facilities with a “yo-yo” history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. 

On October 10th CMS issued a Survey & Certification Memorandum (S&C-09-05) revealing the scoring method for identifying SFF.  According to the CMS Memorandum, the scoring methodology for the SFF comprises two scores: the deficiency score and the revisit score.  Results from the most recent surveys are weighted more heavily than results from earlier surveys.  After more than a year of requests by AHCA to CMS, including a Federal Freedom of Information Act request, CMS responded by making this critical information public. 

The S&C memo describes the selection methodology as a five-step process:

1. Health Deficiencies: Health Deficiencies are scored and weighted.
2. Revisits: If the facility required more than one revisit to demonstrate substantial compliance, additional points are added to the SFF score.
3. Weighting by Year: Results are totaled and weights are assigned to each period, with more recent results weighted more heavily.
4. List per State: The facilities are grouped within each State and the 15 facilities with the highest SFF scores (i.e. most serious and persistent health care deficiency histories) are presented to the State for consideration as SFF facilities.
5. State Recommendation and Selection: Each State reviews the candidate list, brings its State-specific knowledge and information to bear (e.g. results of State licensure surveys), and recommends a final selection to CMS.

A detailed description of the scoring method is available by reading the S&C Memorandum.