Medicare Compliance & Reimbursement

Grassley says certification process "isn't working." An inspection report released July 13 by the HHS Office of Inspector General sums up a slew of inaccuracies on the Nursing Home Compare Web site -- but long-time fraud hawk Sen. Charles Grassley (R-IA) says it's just the tip of the iceberg. Based on CMS databases and state survey documentation, the report determined that 19 percent of nursing homes on NHC had one or more surveys missing, 11 percent had one or more deficiencies missing from the results, and 15 percent were tagged with deficiencies not found in state survey documentation. And for a Web site that is supposed to provide the foundation of public information regarding all Medicare- and Medicaid- certified homes, Grassley calls such lapses "troubling."

The OIG pins the problems on late data entry by state survey agencies, no tracking of inaccuracy reports by the Centers for Medicare & Medicaid Services and failure of state agencies to transmit data on amended deficiencies. However, inspection results are "largely accurate."

Yet that assertion is only true "if the information is taken at face value and only if the odds are on your side," says Grassley. In a July 13 letter to CMS Administrator Mark McClellan, Grassley reminds that consumers now have a "one in five chance" they will get accurate information on a nursing home.

"Couple those odds with the disturbing reality that the very integrity of the quality data contained in the inspection results and complaint histories has been called into question and the bedrock value of Nursing Home Compare crumbles," says Grassley. Grassley's reaction builds on prior complaints that the survey and certification process is itself corrupted. In a July 7 letter to McClellan, Grassley cited hearings with state surveyors that painted a none-too-pretty picture of the survey process: Results are whitewashed by political pressures, errant homes have plenty of time to conceal deficiencies, and "roller coaster compliance" -- where homes cycle in and out of adherence to regulations depending on their slot in the survey cycle -- is encouraged. The complaint process is also reportedly off track. "Patients or family members are rarely interviewed, administrative and medical records are rarely reviewed, valuable information is routinely recorded incorrectly, and the word of the facility is often taken at face value over that of a resident and/or family member," according to surveyors. Here's what Grassley wants CMS to consider: allow surveyors an outlet to anonymously report corruption; ensure "improvements" in homes with a poor care history are, in fact, real; and conduct exit surveys of surveyors who depart state agencies. To read the OIG report, "Inspection Results On Nursing Home Compare: Completeness And Accuracy" (OEI-01-03-00130), go to www.oig.hhs.gov/oei/reports/oei-01-03-00130.pdf. Lesson Learned: [...]