The Centers for Medicare & Medicaid Services on Wednesday updated its consumer-facing nursing home website to show whether facilities were formally disputing cited deficiencies.

Just over 1,000 disputes were noted. Some of them date back several years in a system that is supposed to take 60 days to review challenges.

Previously, such allegations were not added to Care Compare until after the dispute resolution process was complete, and then only if a panel found against the facility. In about 25% of cases, providers are able to prove they should have received a reduced citation or none at all.

The agency announced last week that appeals using the Informal Dispute Resolution or Independent Informal Dispute Resolution processes would be added to facility listings starting Jan. 25 in line with the administration’s “commitment to transparency.”

An analysis of the data by Formation Healthcare on Wednesday showed 866 health citations in the IDR process, with 87 under IIDR. Another 53 fire safety and emergency preparedness citations were marked as being disputed.

At least one citation being fought by a provider dates to 2017, according to a Formation Healthcare analysis.

“It would be very helpful to know why many of the dispute citations that CMS lists are over three years old, with some as much as six years old at this point,” said Jessica Curtis, Formation’s managing partner. “Those should be resolved by now. If there is a delay because of COVID or litigation, it seems unfair to be posting those publicly.”

Curtis said her team was checking its databases to see if some of the older disputes could actually have been resolved and were reported in error Wednesday.

Broader pushback continues

Meanwhile, those who represent nursing homes are sharing their concerns about the latest CMS tactic more broadly. 

“We appreciate the push for transparency and accountability in nursing homes and support initiatives that will promote positive outcomes — posting disputed citations before resolution and finalization does not serve that purpose,” LeadingAge President and CEO Katie Smith Sloan wrote to CMS Administrator Chiquita Brooks-LaSure on Jan. 23. “You can’t unring the bell. Publicly disclosing citations on Nursing Home Care Compare that are actively under IDR/IIDR contributes to the public conversation in a way that cannot be undone.

A CMS spokeswoman last week told McKnight’s Long-Term Care News that disputes that resolve in the facility’s favor would simply be removed from Care Compare. No further explanation was expected to appear on the site. That approach left at least one legal expert with concerns that the public would not understand the facility had been vindicated. 

The American Health Care Association/National Center for Assisted Living told Bloomberg Law that a better solution would be to improve the inspection “process to be consistent as well as the appeal process to be fair and timely.”

“We believe the current oversight system perpetuates a punitive approach where regulators focus on finding citations and issuing fines, rather than helping providers get better and recognize good faith efforts,” AHCA told Bloomberg in a statement.

But at least one CMS compliance consultant was surprised the initial news was not worse for providers. StarPro’s review found 886 disputed through the IDR process, and 87 under IIDR (reserved for cases involving civil monetary penalties). That was out of some 381,000 deficiencies across more than 15,000 nursing homes.

“Since CMS made such a big deal of it, we thought there’d be more,” noted Spencer Blackman, director of product. 

He added that more than half the disputes involved non-harm deficiencies.

“We’re surprised that so many homes would bother to dispute what seems like a low-stakes tag, but they may be operating in a tight state like New Hampshire where every tag counts, or they may just have been lucky enough not to have harsher tags to dispute,” Blackman added.