Some Care Compare information used by consumers to evaluate nursing homes is too old, and, in some cases, the Centers for Medicare & Medicaid Services needs to add more information to make data more easily understood, a government watchdog said in a new report.
The Government Accountability Office reviewed CMS assessment of the three main sources of nursing home information that feed Care Compare: staffing data, inspections and quality measures.
The agency also evaluated the site based on 15 characteristics related to understandability and relevancy to determine whether it is an effective transparency tool.
It found that, in many ways, CMS was meeting important consumer standards. But when it came to timeliness of reporting, the agency was only minimally aligned with that goal. GAO said information should be no more than two years old to support its relevance to consumers; many health inspection reports featured on the site exceed that recommendation.
GAO also found that Care Compare was not aligned at all with goals to describe key differences in patient experiences, describe key differences in costs, or enable consumers to assess cost and quality information together. A proposed quality measure change would add a patient survey for nursing homes, something that CMS pointed to in interviews with the OIG. An existing OIG recommendation to add cost information “remains open,” OIG added.
The week’s report, one in a series since 2014, came at the request of Sen. Charles Grassley (R-IA), who demanded a review specific to Care Compare’s nursing home section and the data and information it provides, including the Five-Star Rating System.
“Today’s GAO report makes it clear that timely information about a nursing home’s performance, along with patient experience, costs, services provided and much more, needs improvement,” Grassley concluded after seeing the report.
He pointed to concerns about the accuracy of some quality measures examined by the OIG and also being investigated by CMS. OIG noted that CMS uses an automated process to check the completeness of the data that lead to ratings, and the agency endorsed the recent CMS roll out of a validation audits related to schizophrenia diagnoses and the use of antipsychotics.
“If implemented effectively, the additional audits should improve CMS’s awareness of issues with the accuracy of its MDS data and ultimately improve the accuracy of the data,” the OIG said. “These audits are assessing the underlying data for one of ten MDS quality measures, and according to CMS officials, the agency is still determining the appropriate next steps for any further efforts related to MDS quality measure data.”
The idea that more back-office data verification could be coming was welcome news to Grassley.
“As this report found, CMS must work expeditiously to test the accuracy of underlying data going into the Care Compare website, including the utilization of antipsychotic medication,” said Grassley, a former chairman of the Senate Finance Committee, as well as of the Special Committee on Aging.
Grassley is in ongoing discussions with the Department of Health and Human Services and CMS about their quality control efforts of key data, especially since a 2022 HHS Office of Inspector General’s report on psychotropic drug use in nursing homes.
