Image of masked clinician and patient talking in clinic visit

A watchdog agency is calling for a greater emphasis on staffing ratios during future nursing home surveys, saying the Centers for Medicare & Medicaid Services is missing opportunities to use information it already collects.

CMS was tasked with strengthening its oversight of nursing home staffing in a report released Thursday by the Department of Health and Human Services’ Office of the Inspector General. It analyzed the agency’s use of staffing data since its switch to the Care Compare site.

The OIG said that, while CMS has taken steps to build a new source of data on nursing home staffing using Care Compare, it should pursue opportunities to better use the information to help consumers and surveyors.

Analysts, led by Lucio Verani in the OIG Office of Evaluation and Inspections, said CMS could improve its staffing oversight in two ways: by annually sharing information about nursing homes directly with state survey agencies and by more fully integrating staffing data into its survey software. 

The watchdog agency noted CMS already shares information with surveyors but in “limited capacity” by providing a list of nursing homes that have potentially insufficient staffing on weekends. However, the OIG said CMS can build on that effort in several ways. 

For example, CMS could tell surveyors which nursing homes reported fewer hours for registered nurses and licensed nurses than what’s federally required and, in turn, help them more efficiently oversee the staffing requirements.

The agency could also share when a provider frequently reports days with no RN hours, which would allow inspectors to specifically target their documentation reviews to the most relevant dates when RNs might not have been working, the OIG urged. 

CMS, which agreed with the recommendation, said it will work to more efficiently provide useful staffing information directly to surveyors. In its written response, the agency also “reiterated that staffing is a vital component of the quality of care in nursing homes” and “emphasized its commitment to continually improve oversight of nursing homes.” 

The recommendations don’t “seek to change the inspection process,” an OIG spokesman told McKnight’s Long-Term Care News in a statement.

“Similarly, our report did not recommend that [state survey agencies] cite nursing homes for insufficient staffing simply because the nursing homes reported staffing levels that fall below federal requirements,” the spokesman added. 

Other report recommendations called on CMS to provide data to consumers on nurse staff turnover and tenure, ensure the accuracy of non-nurse staffing data used on Care Compare, and consider residents’ level of need when identifying nursing homes for weekend inspections. CMS concurred with these recommendations, as well.

Last month, researchers from the University of California Los Angeles and Harvard Medical School suggested CMS add staff turnover to its star ratings, saying it would hold providers accountable for understaffing and provide consumers valuable information about care delivery.