The Government Accountability Office (GAO) has asked the federal government to keep better track of data on nursing home complaints.
The GAO report, issued Monday, came down on the Centers for Medicare and Medicaid Services' (CMS) oversight of the state nursing home complaint investigation processes, charging that CMS' performance standards system and complaints database is hampered by data reliability issues.
CMS contracts with state survey agencies to investigate complaints about nursing homes from residents, family members and others. CMS helps assure the adequacy of state complaint processes by issuing guidance, monitoring data that state survey agencies enter into its database and annually assessing performance against specific standards.
[See also: U.S. News ranks top nursing homes.]
The GAO report found concerns about the timeliness and adequacy of complaint investigations and CMS' oversight. For the survey, GAO said it examined:
- complaints received, investigated and substantiated by state survey agencies;
- whether those agencies were meeting CMS performance standards and other requirements;
- the effectiveness of CMS' oversight.
In addition to analyzing CMS data on complaints and performance reviews, GAO examined CMS guidance and conducted interviews with officials from three high- and three low-performing state survey agencies and their CMS regional offices.
CMS' complaints data showed that state survey agencies received 53,313 complaints about nursing homes in 2009. Eleven states received 15 or fewer complaints per 1,000 nursing home residents while 14 states received more than 45.
State survey agencies assess the severity of a complaint and assign a priority level, which dictates if and when an investigation must be initiated. About 10 percent of complaints were prioritized as "immediate jeopardy," requiring investigation within 2 working days of receipt, while 45 percent were prioritized as "actual harm – high," requiring investigation within 10 working days of prioritization.
State survey agencies investigated all but 102 complaints that required it, according to GAO. Among investigated complaints, 19 percent were substantiated and resulted in the citation of at least one federal deficiency.
The GAO found that the percentage of immediate jeopardy and actual harm – high complaints that were substantiated with at least one federal deficiency cited was higher if the investigation was initiated on time.
[See also: CMS to launch five star rating system on Nursing Home Compare Website.]
According to GAO, CMS has not made full use of the information it collects because of data reliability concerns, which keep CMS from routinely using data from the complaints database to calculate certain measures that could enhance its understanding of agencies' performance.
GAO recommended that CMS improve the reliability of its complaints database and clarifying guidance for its state performance standards. The Department of Health and Human Services "Times New Roman"">"generally agreed" with GAO's recommendations.
The full GAO report can be found here.
Follow Diana Manos on Twitter @DianaManosHITN.