"This Web site has come a long way," Grassley said. "It's a lot better than it used to be. But there are still flaws and information gaps. We have to fix those flaws and gaps. This is one of the best resources available to the millions of families who need nursing homes for their relatives. As our nation ages, more families will do this kind of shopping. They need the best possible guidance to help them pick a good nursing home."
Grassley said the Nursing Home Compare Web site, located at www.medicare.gov/NHCompare/Home.asp, is meant to serve nursing home consumers the way Consumer Reports magazine serves the buyers of other products. The Web site, maintained by the Centers for Medicare and Medicaid Services, is one of the few -- if not the only -- comprehensive, user-friendly compilations of nursing home performance data that people can search by city and region and use to compare the quality of nursing homes in their area.
Last year, Grassley and a congressional colleague achieved a major step toward improving Nursing Home Compare. At the time, the Web site didn't include information on violations that inspectors found when they inspected nursing homes prompted by complaints from a resident, family member, or nurse. As a result, information on thousands of serious violations was not available on the Nursing Home Compare Web site, potentially misleading families about nursing home conditions.
Grassley and his colleague urged the Centers for Medicare and Medicaid Services to add the complaint data to the Web site. They were successful.
However, a new analysis shows a new problem: the timeliness of the annual inspection and complaint violation data reported on the Nursing Home Compare Web site. It often takes months for these violations to be posted on the Web site, even when a life-threatening violation is involved. As a result, family members using the Web site to find a nursing home for a loved one are all too often relying on incomplete and out-of-date information, Grassley said.
Grassley and his House colleague, Rep. Henry Waxman, just sent a letter to the Centers for Medicare and Medicaid Services to urge a correction of the latest problem.
Grassley has a long record of working to improve the quality of care in nursing homes. Last October, he received an award for "those whose outstanding efforts in public policy have improved the care of nursing home residents." The award came from the National Citizens' Coalition for Nursing Home Reform, one of the nation"s most prominent nursing home resident advocacy groups.
"A lot of people working together have made progress in improving nursing home conditions, but not enough," Grassley said. "Many nursing home residents receive perfectly fine care. But as long as any residents go hungry, or develop painful bed sores, or are beaten by staff, no one who's in a position to change nursing home conditions can rest. Even though we're at war, and many Americans are understandably focused on that, we can't turn away from the one million-plus nursing home residents whose well-being depends on our relentless oversight."
The text of the letter that Grassley co-authored to the Centers for Medicare and Medicaid Services on the lag in posting key nursing home data follows.
March 26, 2003
The Honorable Thomas A. Scully
Administrator
Centers for Medicare and Medicaid Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Mr. Scully:
In February 2002, we wrote to you regarding an important problem involving the "Nursing Home Compare" website maintained by the Centers for Medicare and Medicaid Services (CMS). That letter was prompted by a report we released which found that the CMS website was missing information on tens of thousands of nursing home violations discovered during investigations ofcomplaints.
This problem has since been rectified, and the website now includes information on violations cited during both annual inspections and complaint inspections. We want to commend you for your rapid response. The addition of the complaint violations has resulted in a significant improvement in the quality of information on the website, which we understand receives thousands of visits each month.
However, we are writing this letter because of an additional problem: the timeliness of the annual inspection and complaint violation data reported on the Nursing Home Compare website. A new investigation by the minority staff of the Government Reform Committee indicates that itoften takes months for these violations to be posted on the Nursing Home Compare website, even when a life-threatening violation is involved. As a result, family members using the website to find a nursing home for a loved one are all too often relying on incomplete and out-of-date information.
Presently, CMS State Agency Performance Standards regarding the timeliness of reporting violations are ambiguous and unclear. These standards require that "the average time from the latest date of either the State Agency approval [of the nursing home Plan of Correction] or Informal Dispute Resolution to entry into OSCAR not exceed 20 calendar days." Because the statutory requirements for state agency approval or informal dispute resolution allow these processes to take up to 90 days, the standards effectively allow state regulatory agencies to delay reporting violations to the OSCAR system for months.
These delays in reporting violations are pervasive. Thirty states and the District of Columbia take an average of over two months to report the results of annual inspections to CMS. Eight states -- Minnesota, Iowa, Delaware, Wyoming, New Mexico, Pennsylvania, Maryland, and Illinois -- take an average of over 90 days to report the results of annual inspections to CMS.
An analysis of individual annual inspections indicates that delays between the inspection and reporting are often longer. During the last 15-month inspection period, states conducted 16,485 nursing home inspections. Reporting dates for almost half of these inspections -- 47% - exceeded 60 days. Almost 25% of inspection results were not reported to CMS within 90 days, and over 10% of inspection results were not reported within 120 days. The results of 476 annual inspections were not reported to CMS within six months of the inspection.
These long delays in reporting occur even in cases of severe violations. Analysis of CMS annual inspection data indicate that in the most recent annual inspections, states identified 699 violations that placed residents in "immediate jeopardy." But more than one-quarter of these violations -- 189 violations -- were not reported to CMS within 90 days. One of every seven of these violations -- 99 violations -- was not reported to CMS within 120 days.
Similar delays appear to be occurring in the reporting of complaint investigation violations. According to CMS data on complaint inspections conducted during the first six months of 2002, 29 states and the District of Columbia take an average of over two months to report the results of complaint investigations to CMS. Eight states -- Maryland, Alaska, Wyoming, New York, New Hampshire, New Mexico, and Virginia -- and the District of Columbia take an average of over three months to report the results of complaint investigations to CMS. In Maryland, the average period between the time a complaint investigation identified a violation and the time the violation was reported to CMS was over six months.
As in the case of annual inspections, an analysis of individual complaint violation reports indicates that delays between the complaint investigation and reporting are often longer than the averages. In the first six months of 2002, states reported 5,082 nursing home complaint violations. Reporting dates for 41% of complaint violations exceeded 60 days, reporting dates for 21% of complaint violations exceeded 90 days, and over 10% of complaint violations were not reported within 120 days. The results of 175 complaint violations were not reported to CMS within six months of the inspection.
We understand that a certain amount of delay in reporting inspection results to CMS is inevitable. For example, once a nursing home is cited for a violation, the home has up to 45 days to file a Plan of Correction, and states cannot report the violations to CMS until either the Plan ofCorrection has been approved or the 45 days have elapsed. However, a number of states were able to keep their average reporting delay to 45 days or less. In 10 states, the average reporting delay for annual inspection results was 45 days or less. In 15 states, the average delay for complaint investigations was 45 days or less, including several states that are averaging reporting times of less than one month.
Ensuring timely reporting by all states would significantly increase the amount of information available to families. Nationwide, nursing homes are cited for an average of 285 violations daily. Thus, reducing the national average in reporting violations by 30 days would provide families who use the Nursing Home Compare with information on over 8,500 violations that are presently unavailable. This additional information would be invaluable to family members who use Nursing Home Compare to choose a nursing home for a loved one.
We are thus requesting that you take immediate steps to ensure that states begin reporting all nursing home violations to the Nursing Home Compare database within 45 days of citation, or more rapidly as circumstances warrant. In order to allow us to track your progress in meeting this goal, please include information on reporting delays in all future biannual progress reports. In the interim, please provide us with a reply to this letter, and a plan to reduce reporting times by April 15, 2003.
Sincerely,
| Henry A. Waxman Ranking Minority Member Committee on Government Reform U.S. House of Representatives |
Charles E. Grassley Chairman Committee on Finance U.S. Senate |