According to McKnight's, Formation Healthcare Group found in analyzing the data that 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 (CMS) initially said would not affect star ratings used by the public. The agency reversed course in December. Many were critical of the reversal, even as the new ratings were published.
Jessica Curtis, Formation’s managing partner, explained to McKnight's 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.
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. .
About 2,800 gained one star or more for improved 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. In 2019, one-third of institutions saw a rating drop specifically due to staffing levels, thanks in part to a new survey method preventing institutions from misrepresenting their level of staffing. In all other categories, the number of institutions gaining a star or more was essentially the same as the number losing one or more.
Overall, 9,937 facilities, or about 66% nationwide, kept the same overall star rating.
“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. That doesn't suggest that the incidence of reported abuse has declined, however, just that the number of facilities with a reportable incidence of abuse has declined. Moreover, while the rating system is helpful in comparing institutions, the rating system does not accurately reflect resident safety.
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 told McKnight's that the wide variation was not directly attributable to COVID outbreaks.
Analysts at Formation Healthcare likewise found discrepancies between states in reporting. Shockingly, several states are far behind in conducting health inspections. For example, Oregon (37%), Georgia (31%), Maryland (26%) and Virginia (21%) led the nation in the share of SNFs last inspected more than two years ago. In other words, in some states, the data on nursing homes may be inaccurate or outdated for almost one-third of the state's institutions.
The pandemic, governments' response to the pandemic, and institutional safety and quality are only making more arguments for the already overwhelming case for aging in place. Plan now.
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