"The data on the website are incomplete and unreliable," Waxman said. "The public is not getting good information when they investigate nursing home quality. Many nursing homes that appear to have clean records on ?Nursing Home Compare' actually had serious problems."
Grassley said, "Anyone who's tried to find a nursing home for a family member knows how hard it is to get useful information about the quality of care in a particular nursing home. The federal website is one of the few tools available to nursing home consumers, and as such, it has to be accurate, complete, and easy to use. A little information is worse than no information if it builds a false sense of security about nursing home quality. The government has had this website up for years. It needs to get it right."
"Nursing Home Compare," which is part of the Department of Health and Human Service's Medicare.gov website, is used by millions of families to identify safe nursing homes. The most important information on the site is a searchable database of nursing home violations that is supposed to allow the public to determine the compliance status of individual nursing homes. HHS says the site is "filled with reliable health care information . . . [to] help you . . . locate nursing homes for yourself or a loved one."
The new report reveals that violations found and substantiated by state inspectors during investigations of nursing home complaints are excluded from "Nursing Home Compare." Between Oct. 1, 2000, and Dec. 31, 2001, these complaint investigations resulted in 25,204 documented violations of federal health standards, but no information on any of these violations appears on "Nursing Home Compare." The violations that are excluded from "Nursing Home Compare" include 59 percent of the most serious violations (those involving death or serious injury) and 41 percent of the violations of the next most serious violations (those that cause actual harm to residents).
To provide complete information to the public, Waxman and Grassley announced that they have posted the missing information on nursing home violations on a congressional website: www.house.gov/reform/min. "HHS needs to get this information to the public as soon as possible. But for now, anyone can go to my committee website to locate this critical information on nursing home quality," Waxman said.
In response to these findings, Waxman and Grassley are sending the report to Thomas Scully, Administrator of the Centers for Medicare and Medicaid Services, and calling on him to immediately revise the "Nursing Home Compare" website to include all nursing home violations.
Attachments:
(1) Letter to Thomas Scully, Administrator of the Centers for Medicare and Medicaid Services
(2) Report, "HHS Nursing Home Compare Website Has Major Flaws," Feb. 21, 2002
February 21, 2002
Thomas A. Scully
Administrator
Centers for Medicare and Medicaid Services
200 Independence Ave., SW
Washington, DC 20201
Dear Mr. Scully:
We are writing to inform you of a critical problem with the "Nursing Home Compare" website maintained by the Center for Medicare and Medicaid Services.
As you know, this website receives approximately 100,000 visits per month and is used by millions of families to help in the critically important decision of choosing a nursing home. To promote the website, the Department of Health and Human Services recently ran a $30 million advertising campaign urging seniors to use the site as a resource "filled with reliable health care information . . . [to] help you . . . locate nursing homes for yourself or a loved one."
The most important information on the site is a searchable database that allows the public to determine the compliance status of virtually any nursing home in the United States. (1)
The "Nursing Home Compare" website contains violations found during annual inspections of nursing homes conducted by state officials. But it does not contain any violations found during complaint investigations conducted by the same state officials. Between October 1, 2000, and December 31, 2001, states investigated approximately 52,000 complaints about conditions in nursing homes. These state complaint investigations resulted in 25,204 documented violations of federal health standards, all of which are excluded from "Nursing Home Compare."
This exclusion means that the HHS website provides unreliable information to the public. The most severe nursing home violations are "immediate jeopardy" violations, which are defined as violations that cause or have the potential to cause death or serious injury to residents. Between October 1, 2000, and December 31, 2001, nursing homes in the United States were cited for 1,923 immediate jeopardy violations. "Nursing Home Compare," however, contains data on only 785 of these violations. Most of the immediate jeopardy violations -- 1,138 violations (59 percent of the total) -- were discovered during complaint investigations. They are not disclosed to the public on "Nursing Home Compare." Similarly, 41 percent of the violations in the second-most severe category -- those that caused actual harm to residents -- are excluded from "Nursing Home Compare" because they were found during complaint investigations.
One consequence of excluding the results of complaint investigations is that the compliance status of many nursing homes is incorrectly portrayed on "Nursing Home Compare." There are 871 nursing homes in the United States that were cited for immediate jeopardy violations between October 1, 2000, and December 31, 2001. Over half of these nursing homes (471 facilities) are not identified on "Nursing Home Compare" as having any immediate jeopardy violations. And over 1,300 nursing homes that had actual harm violations are misidentified on "Nursing Home Compare" as having no actual harm violations.
These defects in "Nursing Home Compare" are completely unacceptable. Families need to have access to the full compliance history of nursing homes so that they can make good decisions for loved ones. Yet in its current form, families are unable to obtain this information from "Nursing Home Compare." As a result, they can be misled about the status of individual nursing homes.
As a temporary step to provide more complete information to the public, we have posted information about the violations found during complaint investigations on the website of the minority office of the Government Reform Committee (www.house.gov/reform/min). This is not a viable permanent solution, however. Our congressional offices are not set up to maintain a database like this on an ongoing basis. Moreover, the public should be able to obtain all of the relevant information from one site.
We recognize that "Nursing Home Compare" was developed in 1998, before you became CMS Administrator. But now that this shortcoming has been identified, we believe that it is your responsibility to fix the problem. We urge you to ensure that the missing violations are available to the public through "Nursing Home Compare" within 30 days.
We look forward to working with you to resolve this important matter expeditiously.
Sincerely,
| Henry A. Waxman Ranking Minority Member House Committee on Government Reform |
Charles E. Grassley Ranking Minority Member Senate Finance Committee |
(1) Special Investigations Division, Committee on Government Reform, Minority Staff, "HHS Nursing Home Compare Website Has Major Flaws," Feb. 21, 2002.