Data lapses did not affect Five-Star ratings, CMS says as providers call for review of agency’s oversight

The Centers for Medicare & Medicaid Services said Wednesday it was taking “seriously” a damning report that questioned the accuracy of information it posted on its Care Compare site, but added that missing data didn’t necessarily affect consumers’ use of the site.

Health, life safety and emergency preparedness deficiencies were underreported at an estimated two-thirds of all US nursing homes in 2020,  the Department of Health and Human Services Office of Inspector General said in issuing an audit report Tuesday.

“CMS examined the root causes of OIG’s findings, and — while the audit review sample size only included 100 nursing homes — CMS takes the findings seriously and has already corrected each issue identified,” a CMS spokesperson told McKnight’s Long-Term Care News in an email Wednesday. 

“The issues identified in this audit did not have a meaningful impact on the way a consumer would perceive the quality of care provided by a nursing home; nearly all of the issues described in the report did not affect the Five-Star Quality Ratings displayed on Care Compare,” the agency added.

But the audit, which follows one of a similar nature in 2004, brings renewed attention to accuracy and might ultimately lead to providers having more negative survey results highlighted online. The OIG recommended that CMS add more manual checks of Care Compare data  to ensure it accurately reflects inspection reports. It also called on better training for state surveyors and others involved in translating survey findings into online postings.

But the audit also raises questions about the agency’s overall approach to regulation and transparency.

“Providers and consumers alike rely on the Center for Medicare & Medicaid Services, the government agency responsible for nursing home quality oversight, to deliver reliable and accurate data on care delivery,” said Janine Finck-Boyle, vice president of health policy for LeadingAge. “The HHS’ OIG report findings raise serious questions about CMS’ ability to do that. While the OIG sample is small, the results further reinforce the April 2022 National Academies of Science, Engineering and Medicine Committee’s call for wide-ranging, systemic change in America’s nursing homes — including a more effective approach to regulation.” 

Association wants changes

The American Health Care Association said it supported efforts to resolve issues identified by the OIG. But it also sought to illustrate continued inaccuracies as another reason to improve CMS’ approach to nursing home regulation.

“Especially coming out of the pandemic, this situation also presents an opportunity to reconsider the status quo,” AHCA told McKnight’s late Wednesday. “The current survey and enforcement system has been shown to be inconsistent and ineffective, and one of our major reform proposals includes improving the oversight process. We will continue to advocate for this improvement.”

As noted by CMS in its statement to McKnight’s, the Care Compare website and its Five-Star Quality Rating System pull data from more than 250,000 health, infection control, complaint, and fire safety compliance inspection surveys compiled by roughly 5,000 surveyors for over 15,000 nursing homes.

Given the large amount of data needed to calculate the ratings, CMS has enacted a series of “validation checks to ensure the data files are correctly displayed,” the agency said, noting that it had made some changes between the data used for the 2020 audit and its publication this week. The agency said it would continue to work with OIG to make improvements.

Jessica Curtis, managing partner for Formation Healthcare, noted that 100 facilities is a “really small sample to review.” She said she was uncertain whether OIG’s extrapolation that 10,303 nursing homes were likely affected by missing deficiencies is itself accurate.

“We do not see that level of discrepancy in our real-time Quality In-Cite data coming from state survey documents compared to Care Compare, and our sample size is much larger,” Curtis said.

Her system, however, sees near real-time stats, while the audit looked at findings from those 100 nursing homes in 2020. CMS said many deficiencies from that time, and potential reporting lapses that led to them, are no longer in play.

Another reason for worry

Still, any questions about accuracy remain a concern for providers whose quality is measured by CMS and listed publicly for the world to see. Curtis pointed out a new wrinkle, too: While consumers may be hurt by missing information, wrong information also could affect competing facilities that receive lower Five-Star ratings due to a peer with data discrepancies being rated higher than deserved. 

“It definitely sounds like their data transmission and QA processes have a lot of room for improvement,” Curtis said of CMS. “We do think that erroneous and missing data can often have ‘a meaningful impact on the way a consumer would perceive the quality of care provided by a nursing home,’ especially when it comes to being aware of the current data.”

In addition to making its information more accurate, she urged CMS to speed up the process by which it gets surveyors’ information to consumers.

“Many families, lenders and owners are making important decisions based off of outdated information which does not reflect the current quality issues,” Curtis added. “Perhaps a more automated and thorough transmission and QA process would allow for more timely public availability as well.”