http://www.medicare.gov/NHCompare/home.asp

One of the most shocking things I learned early on about researching nursing homes came directly from the federal government.

Each day that I work for reforms, countless consumers are making decisions, often with little advance notice, about placement for themselves or a loved one.  The following are my observations about the Center for Medicare and Medicaid Services (CMS) website. 

The CMS website is a compilation of data from the Annual Surveys of nursing homes which are usually conducted every 12 to 15 months.  Annual Surveys are to be conducted "with no prior announcement", yet it is reasonable to assume that any facility can determine what their three-month window of opportunity for an Annual Survey will be. 

Data on this CMS website: 

"About the Nursing Home" 
This provides information about occupancy limits, current occupancy, type of ownership, etc. However, the section does not specify who actually owns/operates the facility. 

"Resident Characteristics" 
This data shows the prevalence of residents with pressure sores, restraints, unexplained weight gain or loss, behaviors, etc., within a particular facility, compared to the state and national averages.  It is, however, provided solely by the facilities themselves and is not audited by anyone. 

"Nursing Staff" 
This shows the individual staff ratio averages of a facility compared with the state and the U.S.  The information, once again, is provided by the facility itself and is not audited by anyone.  A recent congressionally-mandated study, which was required to be completed by January 1, 1992, was finally released this year revealing that nine out of ten nursing homes have insufficient staff. 

Senator Chuck Grassley (Ranking Member, Senate Committee on Finance) and Representative Henry Waxman (Ranking Member, Committee on Government Reform) sent a letter to Thomas Scully, Administrator of CMS, on April 17, 2002, expressing their disappointment that CMS is not posting the report on the agency's web site.

Last, but most important: 

"Inspection Results" 
This is a starting point for evaluating the performance of the facility.  However, the data is based solely upon predicted Annual Surveys.  It does not reflect the effects of individual Complaint Investigations (complaints filed by residents, family members, etc.). 

What does this mean for consumers? 

An example will be a facility with which I am totally familiar.  A homicide occurred in the facility in 1999 and was verified in 2000.  Any information regarding the resulting citations and/or civil money penalties imposed due to that homicide are not reflected on the CMS web site anywhere, then or now.  Neither will consumers see a current Complaint Investigation about yet another homicide appear for consumers to consider, even if it is verified by regulatory agencies.  This facility continues to present a nearly flawless record, according to this CMS website. 

Another example would be a validated rape in a facility which may be confirmed through a Complaint Investigation.  That rape and any resulting citations and/or fines will not appear on the CMS web site. 

On February 21, 2002, a report by the Minority Staff Special Investigations Division of the Committee on Government Reform verified these discrepancies in the CMS website.  A quote from this report states:  "In a recent $30 million ad campaign, HHS advertised the site as being 'filled with reliable health care information...[to] help you...locate nursing homes for yourself or a loved one.'  Contrary to these assertions, however, the data in 'Nursing Home Compare' actually excludes many documented violations of federal health standards." [Source:  HHS 'Nursing Home Compare' Website Has Major Flaws, 02/21/02].  In a letter from Congressman Waxman and Senator Grassley on February 21, 2002, to Mr. Scully, they make the statement that, "This exclusion means that the HHS website provides unreliable information to the public....These defects in 'Nursing Home Compare' are completely unacceptable."  During my visit to Congressman Waxman's office in 2000, I pointed out this flagrantly-flawed CMS data to his staff; thus, this Special Investigation Division prepared the report revealing these discrepancies upon which consumers rely. 

While on-site, personal visits to a potential nursing home at various times of day/evening are an essential part of forming an impression, the history of a facility's performance should be available in complete, reliable form. 

On February 20, 2002, Secretary of Health and Human Services Tommy Thompson was quoted in a PR Newswire article as saying, "People covered by Medicare and Medicaid have the power to choose the best care to meet their individual needs, but they have to have more reliable information to choose quality care."  Is this "reliable information" only to be provided if the 'news is good news'?? 

If CMS could spend $30 million on an ad campaign touting the website in its current flawed form, then the additional Complaint Investigation data and audited information regarding staffing levels, resident characteristics, etc., should be mandatory and a "lack of funds" will seem a flimsy excuse. 

CMS is currently preparing to release six-state Quality Indicator report for nursing homes, which is to be added to the CMS website.  It is my understanding that this is, once again, based solely upon data provided by the facilities themselves and is not audited. 

I have asked Mr. Scully twice how this new Quality Indicator report would reflect two homicides in two years in one facility.  He has not yet responded to either request for an answer. 

Keep in mind, also, that a zero-deficiency report ONLY means that a facility is meeting MINIMUM STANDARDS. 

Let CMS and/or HHS hear from you regarding the unreliability of this website for consumers.  Also send copies of your letters to Senator Charles Grassley, Congressman Henry Waxman and Senator John Breaux, Chairman, U.S. Senate Special Committee on Aging.  Our tax dollars provide most of the funding for nursing homes.  I believe we have a right to access all data and that the data should be audited.  The addresses are listed below for your convenience in writing letters. 

                          # # # # # # # # # # # # # # # # # # # # # # # # # # #
 
 

Mr. Thomas Scully, Administrator 
Centers for Medicare & Medicaid Services (CMS) 
7500 Security Boulevard 
Baltimore MD 21244-1850 

Secretary Tommy Thompson 
The U.S. Department of Health and Human Services (HHS) 
200 Independence Avenue, S.W. 
Washington, D.C. 20201 
(202) 619-0257 

U.S. Representative Henry A. Waxman 
Ranking Minority Member 
U.S. Committee on Government Reform 
2204 Rayburn House Office Building 
Washington, DC 20515 

U.S. Senator Charles Grassley 
Ranking Member 
U.S. Senate Finance Committee 
135 Hart Senate Office Building 
Washington, DC 20510-1501 

U.S. Seantor John Breaux 
Chairman, U.S. Senate Special Committee on Aging 
Hart Senate Office Building, Room #503 
Washington, DC 20510-1803