The Government Accountability Office (GAO) recently issued a report, “Nursing Home Quality: CMS Should Continue to Improve Data and Oversight,” examining changes in reported nursing home quality and related CMS oversight activities. According to the GAO, three nursing home data sets—standard survey deficiencies, reported staffing levels, and clinical quality measures—indicate potential improvement in nursing home quality, with the number of serious deficiencies identified per home decreasing by 41% from 2005 to 2014. Conversely, the GAO points out that consumer complaints reported per nursing home increased by 21% during the same period. The GAO contends that various data issues, such as state variations in the recording of consumer complaints and the self-reported nature of nurse staffing and quality measure data, make it difficult for CMS to assess quality trends. The GAO also discusses several modifications CMS has made to its nursing home oversight activities in recent years, such as changes to Special Focus Facility program, but observes that CMS has not monitored the potential effect of these modifications or changes in state survey agency practices on nursing home quality oversight.
Based on its findings, the GAO recommends that CMS:
- establish specific timeframes and milestones for the development and implementation of a standardized survey methodology across all states;
- implement a plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing data and data used to calculate clinical quality measures; and
- establish a process for monitoring modifications of CMS and state survey agency oversight activities to better understand the effects on nursing home quality oversight.