OIG Presents Ways to Improve Quality of Nursing Home Care

On May 15, 2008, Lewis Morris, Chief Counsel to the Inspector General, presented testimony entitled "In the Hands of Strangers: Are Nursing Home Safeguards Working?" before the House Energy and Commerce Committee's Subcommittee on Oversight and Investigations.

In his testimony, the Chief Counsel describes the studies, enforcement actions, initiatives and government-industry collaboration that the Department of Health and Human Services' Office of Inspector General (OIG) has undertaken to identify ways to improve the quality of nursing home care. The Chief Counsel also offers some suggestions for consideration, including:

• Improve screening of all nursing home staff by creating a nationwide centralized database that includes information from OIG's exclusions database, state nurse aide registries, and disciplinary actions by state licensing boards. 
• Create a demonstration project to establish mandatory compliance programs for selected nursing homes.
• Enhance the quality-of-care data made available to the nursing home industry and the public.

On May 9, 2008, the U.S. Government Accountability Office (GAO) also released a report entitled "Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses." According to the report, during fiscal years 2002 through 2007, about 15 percent of federal comparative surveys nationwide identified state surveys that failed to cite at least 1 deficiency at the most serious levels of nursing home noncompliance - actual harm and immediate jeopardy.  In the report, the GAO recommends that the Centers for Medicare & Medicaid Services (CMS):

• Require regional offices to determine if there was understatement when state surveyors cite a deficiency at a lower scope and severity level than federal surveyors and to track this information.
• Establish quality controls to improve the accuracy and reliability of information entered into the federal monitoring survey database.
• Routinely examine comparative survey data and hold regional offices accountable for implementing CMS guidance that is intended to ensure that comparative surveys more accurately capture the conditions at the time of the state survey.
• Regularly analyze and compare federal comparative and observational survey results.

The GAO reports that it provided a draft of the report to CMS through the Department of Health and Human Services (HHS) and that HHS endorsed and indicated that it would implement the GAO recommendations.