CMS Nursing Home Care Compare Exposed for Underreported Quality Info

April 13, 2023 - A new HHS Office of the Inspector General (OIG) report is putting CMS on blast for not accurately reporting on nursing home issues on the agency’s Care Compare sites, which healthcare consumers use to selectively pick out where to access healthcare.

The OIG report noted that 67 of the 100 sampled nursing homes did not have a flag for one or more of its issues with health, fire safety, and emergency preparedness. The report indicated that the lack of reporting impedes consumers’ ability to make informed decisions about healthcare access.

CMS hosts its Care Compare websites, for which it has many depending on the facility type, to enable more consumerism in healthcare. The websites are tailored for a consumer audience to help them assess their options for healthcare encounters they can schedule. The Nursing Home Care Compare websites help consumers understand the cost and quality of a nursing home before admission.

Typically, CMS populations that quality information in part using assessments from state survey agencies, OIG explained. State survey agencies visit the nursing homes and complete a survey assessment about the healthcare quality, fire safety, and emergency preparedness of each nursing home. From there, CMS uploads that quality data onto Care Compare.

But according to this OIG report, that second part of the process doesn’t always happen. CMS does not always include negative reports from the state survey agencies on the Nursing Home Care Compare website.

READ MORE: Nursing Home Care Compare Limits Effective Patient Navigation

In fact, this happens around 67 percent of the time, the report estimated using its 100-nursing home sample size.

OIG looked at a nationally representative cross-section of 100 nursing homes in the United States and collected information about health, fire safety, and emergency preparedness both from the Care Compare website and the raw data from the state survey agencies.

The Office said the under-reporting is a prevalent problem. For 67 of the 100 nursing homes included in the analysis, CMS failed to report on one or more of their deficiencies on Care Compare.

CMS most commonly failed to report on fire safety problems, with 52 sampled nursing homes having a flag on the state survey report but not on Care Compare. For 34 nursing homes, CMS did not report on health deficiencies.

It was significantly less common for CMS to fail to report on emergency preparedness issues; this was only an issue for two nursing homes. This could be because emergency preparedness problems are less common than fire safety or health deficiencies. That said, OIG did report that CMS did not report on the results of the yearly fire safety and emergency preparedness inspections for 42 of the sampled nursing homes.

READ MORE: Nursing Homes Underreport Patient Safety Events, Pressure Ulcers

It should be noted that 100 is a somewhat small sample size, considering there are around 15,000 nursing homes on the Care Compare website. But if those 100 nursing homes are truly representative of the entire nation, the OIG researchers said the analysis is indicative of a negative situation.

If its sample results hold true, OIG said that means 10,303 nursing homes had one or more deficiencies during inspections left off Care Compare.

That’s 5,228 nursing homes with unreported health deficiencies, 7,996 with fire safety issues, and 308 with emergency preparedness problems. Based on the sample results, OIG estimated 6,458 nursing homes for which CMS did not report the results of yearly fire safety and emergency preparedness inspections.

OIG urged CMS to retroactively correct this misreporting for the sampled nursing homes. And to prevent future issues, the Office suggested that CMS improve the review process for the results it reports on Care Compare. Specifically, OIG recommended that CMS require state survey agencies to verify any reported deficiencies and provide technical assistance and training to state agencies.

OIG said CMS agreed with its recommendations for offering more technical assistance and training but did not comment on other recommendations.

Pitfalls in quality reporting on Care Compare can have consequences for individuals looking for a good healthcare experience. As noted above, CMS launched the websites to help consumers understand their options for care and make informed decisions. Without accurate quality information, consumers are unable to make those decisions.

This latest report has come after some less-than-stellar government reports about Nursing Home Care Compare. In February 2023, the Government Accountability Office (GAO) said Nursing Home Care Compare obscures some nursing home ownership information, which would be pertinent information for individuals making care access decisions.

GAO contended that the Nursing Home Care Compare websites are not usable or navigable, making it hard for users to determine whether a nursing home is part of a national chain. That means that users cannot find accurate quality information about the nursing home. GAO said that the Nursing Home Care Compare website “does not align with the characteristics of effective transparency tools.”

The agency suggested that CMS reexamine its Nursing Home Care Compare websites and assess how they align with transparency best practices. The agency emphasized that CMS should look at how clearly it defines chain ownership and facilitates consumer navigation and access to quality scores.

“CMS has demonstrated a commitment to improving the transparency of nursing home ownership information and has an opportunity to present ownership information in a way that helps consumers make more informed care choices,” GAO said.