The Government Accountability Office (GAO) recently issued a report highlighting concerns with the public accessibility and reliability of skilled nursing facility (SNF) expenditure data collected by CMS. While CMS has posted raw SNF cost report data in accordance with a statutory mandate, the GAO believes the data’s format, volume, and organization makes it difficult for stakeholders to use. The GAO also notes that “the agency performs minimal quality control” of this data to determine accuracy and completeness. The GAO recommends that CMS improve public stakeholders’ ability to locate and use SNF expenditure data, with which CMS concurred. The GAO also recommends that CMS take steps to ensure the accuracy and completeness of the SNF expenditure data, but CMS disagreed, citing the substantial resources that would be required without the potential of significant benefit.
The GAO also analyzed SNF cost report data for fiscal years (FYs) 2011 through 2014 to determine the extent to which SNF expenditures vary by characteristic type (e.g., for-profit versus nonprofit, chain versus independent). The GAO found that direct and indirect care costs were lower on average as a percentage of revenue at for-profit SNFs compared with nonprofit and government SNFs, and lower at chain SNFs compared with independent SNFs. In addition, the GAO determined that median margins were higher for for-profit and chain SNFs than for other SNFs each year reviewed. Based on data from FYs 2012 through 2014, the GAO found that for-profit SNFs generally had lower nurse staffing ratios than nonprofit and government SNFs.