From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Nursing Home Quality

Description: Audio Interview by GAO staff with Linda Kohn, Director,
Health Care

Related GAO Work: GAO-16-33: Nursing Home Quality: CMS Should Continue
to Improve Data and Oversight

Released: November 2015


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[ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and
information from the U.S. Government Accountability Office. It's
November 2015. Nursing homes must meet certain quality standards to
participate in Medicare and Medicaid. To monitor compliance with these
standards, the Centers for Medicare and Medicaid Services use state data
from on-site surveys and other data on nursing home quality. A team led
by Linda Kohn, a director in GAOs Health Care team, reviewed results in
trends in the data and looked at CMS's nursing home oversight
activities. Jacques Arsenault sat down with Linda to talk about what
they found.

[Jacques Arsenault:] Can you give me a sense of the scope or the number
of nursing homes around the country that participate in Medicare or
Medicaid?

[Linda Kohn:] There are almost 16,000 nursing homes across the country
that participate in Medicare and Medicaid. These nursing homes take care
of almost 1 1/2 million people. Residents of nursing homes are generally
elderly and/or disabled individuals. So this is a vulnerable population
and so it's important that the quality of care for these people be as
good as possible.

[Jacques Arsenault:] And what kinds of quality data do the Centers for
Medicare and Medicaid Services, or CMS, collect and use for oversight?

[Linda Kohn:] CMS has several types of data they collect on a regular
basis directly from each of those 16,000 nursing homes. We looked at 4
sets of data. And we actually found mixed results on whether the quality
of care in nursing homes has improved over time. We looked at, for
example, deficiencies identified during nursing home inspections. So if
a nursing home doesn't meet a CMS standard of care, a deficiency is
issued for correction. And our data show that over 10 years, between
2005 to 2014, the number of the most serious deficiencies declined by 41
percent. We also looked at staffing data from 2009 to 2014 and we found
that total nurse hours per resident per day increased by 9 percent more
nurses. We looked at the subset of quality measures that nursing homes
report on that relate to a whole variety of issues such as number of
residents with pressure ulcers or bedsores, or residents who had a fall
with a major injury. We saw a decrease in the number of reported quality
problems between 2011 and 2014. So these measures suggest possible
improvements in quality but over the same time period from 2005 to 2014,
we saw a 21 percent increase in consumer complaints filed, with 30
states showing an increase in the number of complaints coming in. So
that's our mixed picture with some data showing improved care, but a lot
of complaints showing up over the same time period.

[Jacques Arsenault:] Now, in your report you talk about some changes
that CMS has made. Have they improved their oversight?

[Linda Kohn:] CMS has made a number of modifications to its activities
for conducting nursing home oversight. Some of the changes expanded
their oversight activities. So for example, CMS is shifting the source
of data on staffing from self-reported data to getting payroll data from
the nursing homes. It has expanded the tools and training for surveyors
that do on-site inspections. But we also note other changes that may
have reduced CMS's oversight activities. For example, CMS has cut back
on the scope of surveys done by its regional offices that evaluate the
skills of the on-site surveyors. CMS also reduced the number of
facilities that are subject to increase inspections due to a history of
poor performance. CMS said these changes were made because of increasing
responsibilities and limited resources. CMS does not know whether their
own changes had an adverse effect on their ability to oversee nursing
home quality. Now, at the same time that CMS was implementing changes,
states were also implementing some of their own changes, and CMS may not
always know about those. So some of the changes, whether at the federal
or state level, could be positive. They might provide some best
practices on how to work in a resource constrained environment. However,
when the changes affect what CMS identifies as being essential for
oversight, there could be possible concerns.

[Jacques Arsenault:] And, finally, what would you say is the bottom line
of this report?

[Linda Kohn:] Nursing home residents are a vulnerable population who
need to have the best care possible. CMS can do more to assure it has
the information it needs to effectively carry out its oversight
responsibilities and continuously improve the quality of care in nursing
homes.

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