GAO finds mixed results on nursing home quality

Photo: Sheena876 via Flickr

The Centers for Medicare & Medicaid Services does not have adequate procedures in place to ensure potential abuse or neglect of Medicare beneficiaries in nursing homes are identified and reported, according to recent testimony from the HHS Office of the Inspector General (OIG).

While the agency has taken some action, based on earlier OIG recommendations, it has not yet acted on the other suggestions to help consumers better understand nursing home quality and make distinctions between nursing homes.

At a Sept. 6 hearing of the House Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, John Dicken, director of Health Care, Department of Health and Human Services OIG, told committee members that CMS data showed mixed results, with an increase in consumer complaints along with improvements in the quality of care.

Dicken was testifying about the status of recommendations from a 2015 Government Accountability Office (GAO) report. The report found that four key CMS data sets showed mixed results, and data issues complicated the ability to assess quality trends. “We found that data issues (e.g., different states using different data collection methods) complicated CMS’s ability to assess whether the results reflected actual changes,” he said.

About 15,600 nursing homes participate in Medicare and Medicaid. To help ensure that residents receive quality care, the Centers for Medicare & Medicaid Services (CMS) collect data, such as nurse staffing levels in these nursing homes. The GAO has reported for several decades on shortcomings both in the care some nursing home residents received and in the federal and state oversight of nursing home care.

Dicken noted that major improvements have occurred in recent years. These include advances in specific nursing home clinical measures — such as reductions in the use of physical restraints — that can be a sign of improved quality of care. However, he also cited news stories (such as this one by Kaiser Health News), which flagged serious fluctuations in nursing home staffing as well as fewer nurses and caretakers than previously reported to CMS.

CMS uses the data to assess quality measures used when determining Medicare payments to nursing homes, so any problems — and CMS’s internal controls related to the data — could affect the accuracy of payments, Dicken said.

“CMS has taken some actions to address these data complications,” he said.  “However, more work is needed. Collectively, these data issues have broader implications related to nursing home quality trends, including potential effects on the quality benchmarks, CMS sets and consumers’ decisions about which nursing home to select.”

The use of quality data for payment purposes will expand in fiscal 2019 with implementation of a nursing home value-based purchasing program. This will increase or reduce Medicare payments to nursing homes based on certain quality measures. CMS has made numerous modifications to its nursing home oversight activities in recent years but had not monitored the potential effect of these modifications on nursing home quality oversight, according to the GAO.

While CMS has made numerous modifications to its nursing home oversight activities, such as creating new training for state surveyors on unnecessary medication usage, the GAO found other modifications reduced existing activities, like cutting some nursing homes from the Special Focus Facility program. This program provides additional oversight of certain homes with a history of poor performance; it was reduced by over half from 2013 to 2014. CMS officials told the GAO that some of the reductions to oversight activities were due to limited staff and financial resources. However, CMS has not monitored how the modifications might affect its ability to assess nursing home quality, Dicken said.

CMS has successfully complied with a GAO recommendation that it establish and implement a standardized survey in all states, but still was working on additional recommendations. Among these: a clear plan for ongoing auditing to ensure the reliability of self-reported data, data used to calculate clinical quality, measures monitoring modifications of essential oversight activities made at the federal, state or regional levels.

Journalists may want to check Nursing Home Compare star ratings to see how revisions like payroll staffing data may have changed ratings or consumer perceptions of nursing homes in their area. Also ask: What specific actions are homes in your community taking to address staffing or other quality measures?

Leave a Reply