Report calls for CMS to get tougher with nursing home complaint investigations

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Report calls for CMS to get tougher with nursing home complaint investigations
Report calls for CMS to get tougher with nursing home complaint investigations

The Government Accountability Office has released a report calling on the Centers for Medicare & Medicaid Services to implement more oversight into nursing home complaint investigations.

Following inquiries from Congressional leaders, the GAO conducted an analysis of CMS's complaints database, where state agencies report complaints and document their investigation results. The GAO found that state survey agencies received 53,313 complaints about nursing homes during fiscal year 2009. The number varied significantly from state to state: 11 states received 15 or fewer complaints per 1,000 nursing home residents while 14 states received more than 45, according to the report.

Nineteen state agencies had trouble investigating harm-high complaints and incidents within the timetable required. Additionally, the report reveals that CMS oversight of state agencies' complaint investigation processes is flawed due to unreliable data.  

The GAO made several recommendations. It suggested that to ensure reliability, the CMS administrator should identify issues with data quality and clarify guidance to states about how particular fields in the database should be interpreted. This could be as simple as defining what it means to substantiate a complaint, the report says. Another suggested strategy encourages state survey agencies to prioritize complaints based on their level of egregiousness.

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