CMS’ incomplete, inaccurate data on COVID-19 cases, deaths and availability of personal protective equipment in nursing homes could hinder the government’s response to hot spots, HHS Office of Inspector General found in a report released Friday (Sept. 3). Nursing homes and resident advocates support the OIG’s suggestions that CMS improve the quality of data and align that data with state data, but CMS says it doesn’t have the authority to standardize data with the states.
CMS in April of 2020 required nursing home facilities to weekly report COVID-19 data to the Centers for Disease Control and Prevention. CMS publishes that information online, including case counts, deaths of residents and staff, and supplies of protective equipment and ventilators.
But a House Ways & Means investigation found large gaps in CMS’ COVID-19 data, making it difficult to assess death rates and staffing needs and to allocate provider relief funds. An independent commission said it’s not worth the effort to report data if it isn’t being used to fix problems such as protective equipment shortages.
The OIG report released Friday found about 5% of the 15,388 nursing homes had incomplete or inaccurate data on COVID-19 cases after CMS performed its quality assurance checks. These checks are meant to reduce misrepresentation and inaccuracies in the data, but OIG staff found they didn’t always catch errors.
“When CMS’s COVID-19 data are complete and accurate, Federal and State officials and other stakeholders may be able to more effectively monitor trends in infection rates and develop public health policies when making decisions about how to ensure the health and safety of nursing home residents and staff,” OIG’s report says. “Incomplete or inaccurate data could delay CMS’s ability to detect and respond to an emerging COVID-19 hotspot, such as a surge or resurgence of COVID-19 cases in a community.”
The OIG report also shows CMS does not contact all nursing homes that failed quality assurance checks, so some facilities might not know they may need to verify and revise their reported data. CMS didn’t set up processes to identify which nursing homes submitted partial data and didn’t create a protocol to reach out to nursing homes to ask them to send CMS the complete information.
OIG recommends CMS provide technical assistance to nursing homes that fail quality assurance checks and suggests the agency collect the same data that states collect.
Standardized reports might improve stakeholder trust in the information. Differences in CMS’ and states’ COVID-19 data can make it confusing to lawmakers and advocates who then have to figure out which set of data they should rely on.
The American Health Care Association/National Center for Assisted Living agrees streamlined collection of standardized data would improve the value of the information.
“Our nursing home staff need to be focused on taking care of their residents,” AHCA said in an email. “We must also focus on using this data to help direct resources to nursing homes in need.”
CMS agrees with half of OIG’s six recommendations. It disagrees with the standardizing data recommendation.
“We understand that CMS does not have the authority to mandate that States align COVID-19 data elements in their own reporting systems with Federal reporting requirements,” the OIG said. “However, CMS, CDC, and State health departments may be able to work together, to the extent possible, to use comparable data elements and monitor substantial differences in CMS’s COVID-19 data and States’ data.”
CMS asked OIG to remove the last two recommendations, saying the CDC corrected errors the OIG identified with the death rates and suspected COVID-19 case counts.
While this corrects the future information, the OIG said CMS needs to verify previously reported data on deaths and case counts.
The OIG found in June about 40% of Medicare beneficiaries in nursing homes had, or probably had, COVID-19 — dually eligible residents and Black, Hispanic and Asian beneficiaries had higher infection rates than whites.
HHS Inspector General Finds CMS’ Nursing Home COVID-19 Data Flawed
Inside Health Policy
September 3, 2021 11:33 am
CMS’ incomplete, inaccurate data on COVID-19 cases, deaths and availability of personal protective equipment in nursing homes could hinder the government’s response to hot spots, HHS Office of Inspector General found in a report released Friday (Sept. 3). Nursing homes and resident advocates support the OIG’s suggestions that CMS improve the quality of data and align that data with state data, but CMS says it doesn’t have the authority to standardize data with the states.
CMS in April of 2020 required nursing home facilities to weekly report COVID-19 data to the Centers for Disease Control and Prevention. CMS publishes that information online, including case counts, deaths of residents and staff, and supplies of protective equipment and ventilators.
But a House Ways & Means investigation found large gaps in CMS’ COVID-19 data, making it difficult to assess death rates and staffing needs and to allocate provider relief funds. An independent commission said it’s not worth the effort to report data if it isn’t being used to fix problems such as protective equipment shortages.
The OIG report released Friday found about 5% of the 15,388 nursing homes had incomplete or inaccurate data on COVID-19 cases after CMS performed its quality assurance checks. These checks are meant to reduce misrepresentation and inaccuracies in the data, but OIG staff found they didn’t always catch errors.
“When CMS’s COVID-19 data are complete and accurate, Federal and State officials and other stakeholders may be able to more effectively monitor trends in infection rates and develop public health policies when making decisions about how to ensure the health and safety of nursing home residents and staff,” OIG’s report says. “Incomplete or inaccurate data could delay CMS’s ability to detect and respond to an emerging COVID-19 hotspot, such as a surge or resurgence of COVID-19 cases in a community.”
The OIG report also shows CMS does not contact all nursing homes that failed quality assurance checks, so some facilities might not know they may need to verify and revise their reported data. CMS didn’t set up processes to identify which nursing homes submitted partial data and didn’t create a protocol to reach out to nursing homes to ask them to send CMS the complete information.
OIG recommends CMS provide technical assistance to nursing homes that fail quality assurance checks and suggests the agency collect the same data that states collect.
Standardized reports might improve stakeholder trust in the information. Differences in CMS’ and states’ COVID-19 data can make it confusing to lawmakers and advocates who then have to figure out which set of data they should rely on.
The American Health Care Association/National Center for Assisted Living agrees streamlined collection of standardized data would improve the value of the information.
“Our nursing home staff need to be focused on taking care of their residents,” AHCA said in an email. “We must also focus on using this data to help direct resources to nursing homes in need.”
CMS agrees with half of OIG’s six recommendations. It disagrees with the standardizing data recommendation.
“We understand that CMS does not have the authority to mandate that States align COVID-19 data elements in their own reporting systems with Federal reporting requirements,” the OIG said. “However, CMS, CDC, and State health departments may be able to work together, to the extent possible, to use comparable data elements and monitor substantial differences in CMS’s COVID-19 data and States’ data.”
CMS asked OIG to remove the last two recommendations, saying the CDC corrected errors the OIG identified with the death rates and suspected COVID-19 case counts.
While this corrects the future information, the OIG said CMS needs to verify previously reported data on deaths and case counts.
The OIG found in June about 40% of Medicare beneficiaries in nursing homes had, or probably had, COVID-19 — dually eligible residents and Black, Hispanic and Asian beneficiaries had higher infection rates than whites.