GAO Issues Report on Nursing Home Quality

The Government Accountability Office (GAO) report found that the Centers for Medicare and Medicaid Serivces (CMS) has made numerous modifications to its nursing home oversight activities, but has not monitored the potential effect of these modifications on nursing home quality oversight. Some of these modifications have expanded or added new oversight activities, while others have reduced existing oversight activities. According to CMS, some of the reductions to oversight activities are in response to an increase in oversight responsibilities and limited number of staff and financial resources. However, CMS has not monitored how the modifications might affect CMS's ability to assess nursing home quality.

The GAO report notes that nationally, one of the four data sets—consumer complaints—suggests that consumers' concerns over quality have increased, while the other three data sets—deficiencies, staffing levels, and clinical quality measures—indicate potential improvement in nursing home quality. For example, the average number of consumer complaints reported per home increased by 21 percent from 2005-2014, indicating a potential decrease in quality. Conversely, the number of serious deficiencies identified per home with an on-site survey, referred to as a standard survey, decreased by 41 percent over the same period, indicating potential improvement. The CMS ability to use available data to assess nursing home quality is complicated by various issues with these data, which make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both.

The GAO recommends that CMS establish improved milestones to track survey methodology across all states and establishing improved auditing to ensure reliability of data used to calculate clinical quality measures.

Click here to view the full report.

Contact Elliott Frost, efrost@leadingageny.org, 518-867-8832.