Despite more than 12,000 infection control-related citations given during the COVID-19 pandemic, most U.S. nursing homes didn’t see their ratings change much in updated Five-Star guidance published Wednesday.

An analysis by Formation Healthcare Group found the prevalence of citations has not changed drastically during the pandemic, with the average health tags cited per facility dropping to 8.1 from a prior average of 8.2.

Among more than 22,000 citations issued, more than 12,000 were related to infection control, a factor the Centers for Medicare & Medicaid Services initially said would not affect star ratings used by the public. The agency reversed course in December.

Jessica Curtis, Formation’s managing partner, noted that infection control citations are being driven by the mandated infection control-focused surveys during the pandemic. A group of six frequent F-tags accounted for more than 8,000 citations. Those included:

880Provide and implement an infection prevention and control program.
886Perform COVID19 testing on residents and staff.
689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
885Report COVID19 data to residents and families.
684Provide appropriate treatment and care according to orders, resident’s preferences and goals.
580Immediately tell the resident, the resident’s doctor and a family member of situations that affect the resident.

Despite the inclusion of infection measures in the star calculation, nearly 12,000 facilities saw no change in their health inspection ranking, according to an analysis by Steven Littlehale, Chief Innovation Officer at Zimmet Healthcare Services Group.

Staffing ratings rise slightly

About 2,800 gained one star or more for RN staffing ratings, while fewer than 2,400 saw that factor drop one star or more. Nationally, staffing levels were higher in January 2021 than they were in January 2019 and 2020, Curtis said.

In all other categories, the number of buildings gaining a star or more was essentially the same as the number losing one or more.

According to Zimmet, 9,937 facilities, or about 66% nationwide, kept the same overall star rating.

Overall star rating analysis by Zimmet.

“From a macro view, this is a lot to do about nothing,” Littlehale told McKnight’s Long-Term Care News. “If you’re the provider holding the bag, being dropped from a preferred provider network, triggering loan covenants or consternation from a family member, it means something.” 

He noted that the update includes two quarters worth of COVID-impacted outcomes. He suspects a “national dip” is more likely once all of the 2020 MDS-based outcomes are calculated.

As for the “abuse” icon adopted by CMS in 2019, 459 facilities will see the icon disappear from their listing based on the latest numbers, while 262 facilities will get one.

The latest star ratings also reveal major variations in how and how well states are performing their inspection duties.

“The percentage of facilities receiving deficiencies during infection control surveys vary considerably across the states,” Littlehale said. “Some states see over 60% of their facilities with IC deficiencies, while other states (are) as low as 6%.”

Littlehale said the wide variation was not directly attributable to COVID outbreaks.
Analysts at Formation Healthcare likewise found discrepancies between states. Notably, Curtis said, several states “are far behind in conducting health inspections.” Oregon (37%), Georgia (31%), Maryland (26%) and Virginia (21%) led the nation in the share of SNFs last inspected more than two years ago.