Medicare Compliance & Reimbursement

Nursing homes may be in for more scrutiny.

Nursing homes may think that surveys have gotten tougher in recent years, but a building consensus on Capitol Hill says they still aren't tough enough - and that quality of care is suffering.

That was the message that emerged from the latest in a series of oversight hearings on nursing home quality held by Sen. Charles Grassley (R-IA).

For the 18-month period ending in January 2002, according to a General Accounting Office report released at the July 17 hearing, about one in five nursing homes were cited by state inspectors for "serious deficiencies that caused residents actual harm or placed them in immediate jeopardy."

Were this the first hearing on the subject, GAO's senior health care analyst William Scanlon told the panel, it would be hard to imagine that this represents progress. But in fact, for the 18-month period ending in July of 2000, GAO had found in a previous study that 29 percent of nursing homes, or about 5,000 facilities, had "actual harm" or "immediate jeopardy" deficiencies.

Scanlon added a caveat to this apparent improvement, however: State survey results appear to be underreporting nursing home problems. Between June 2000 and February 2002, when federal inspectors did their own surveys, they found actual-harm or higher-level deficiencies in 22 percent of homes where state inspectors had found no such problems.

Grassley said he would demand a "timeline" from the Centers for Medicare & Medicaid Service for taking GAO-recommended steps to strengthen oversight of the state survey process. But CMS Administrator Tom Scully noted a potential impediment to long-term improvements: CMS's funding for overseeing the survey process has been held flat for several years.

Grassley said he would ask the GAO "to look into the adequacy of federal funding for state survey and certification activities - not just for nursing homes but for other providers, such as home health care."

To see the GAO report, go to www.gao.gov/new.items/d03561.pdf.

Lesson learned: Nursing homes should watch for tougher surveys as concern over quality of care continues to boil in Washington.