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Digesting the Data: CMS COVID-19 Nursing Home Numbers

CMS recently announced that it will regularly share COVID-19 specific nursing home data, as well as a corresponding website where consumers can access some of this data. On a recent webinar, we discussed the data: what it means, and whether it can be helpful to patients and their families as they try to identify an appropriate and safe post-acute option during the ongoing pandemic.

Overview

On April 19, CMS and the CDC first announced that they would partner to collect and publish various information regarding the spread of COVID-19 in skilled nursing facilities, and the preparedness of SNFs in caring for COVID-19 patients. SNFs across the US were provided a May 24 deadline by which they had to report COVID-19 information through the CDC’s National Healthcare Safety Network (NHSN). SNFs must continue contributing this data on a weekly basis for a to-be-determined duration, and CMS will continue to make the data public.

What is remarkable, and unprecedented, about this data is the speed in which CMS has compiled it and made it available. Nursing Home Compare data often lags – particularly the information that is incorporated into Medicare fee-for-service claims measures. Those can be up to a year old when they’re finally published. Contrastingly, CMS conducted the necessary training, collected the data and published it to their website within two months. When the data was posted on June 4, it was only four days old. On June 18, CMS released its second batch of data, which includes information of various COVID-19-related metrics from the last two weeks of May and the first week of June.

What does the data entail?

At a high level, the data released on June 4 covers the spread of COVID-19 in the nursing home setting. Compiling the reports on approximately 14,000 US nursing homes, CMS’s data is comprised of metrics that include:

  • Counts of positive COVID-19 residents and facility personnel (facility-acquired infections and COVID-19 admissions to a nursing home from the hospital)
  • Counts of COVID-19-related mortality among residents and facility personnel
  • Supplies and personal protective equipment (PPE)
  • Staffing shortages
  • Ventilator and capacity issues (only ~400 nursing homes reported having ventilators)

Data concerns: accuracy and interpretation

Following the release of this data, it was immediately apparent that there were some accuracy issues. For the overwhelming majority of post-acute providers, the data is accurate. But the outliers – including, for example, some nursing home facilities that reported more COVID-19 deaths than they even have beds – led some to call into question whether CMS’s data can be trusted.

Further, some questions presented to the nursing homes were vague or objective. For example: “Does your facility have enough of each supply item listed for ONE week?” There are no guidelines for what “enough” means in this context, so it was up to the person answering the survey to decide. Not only do interpretation challenges lie with each nursing home taking the survey, but also with the consumer in attempting to understand this data – and whether it’s related to quality of care at a facility. As they continue to collect and release more data and refine the process, CMS will – hopefully – continue to make improvements.

Challenges interpreting this data

Despite a consumer-facing, interactive map that CMS developed for this data, patients and families may have difficulty using it “as is” to inform decision-making, given the data’s many nuances. In speaking with several of our clients, we identified potential challenges that patients and families may face in correctly interpreting this information:

  • More reported COVID-19 cases ≠ worse care: Many regions – particularly those geographies that have been hard-hit by COVID-19 – designated specific facilities for COVID-19-positive patients. As a result, a given facility may have more suspected or confirmed COVID-19 cases – not necessarily due to poor infection control but because that facility was specifically set up to care for COVID-19-positive patients. As a patient or family member who sees this information, however, it might be misleading without context.

Also, Five Star Ratings and other quality indicators are not correlated with a facility that has more positive infections. In fact, the greatest predictor of a nursing home with COVID-19-positive patients is a facility’s location. A consumer might look at CMS’s data, see the cumulative positive case counts reported and assume that a the facility had quality issues around infection control, but in some cases it just means that the facility is well equipped and prepared to take COVID patients.

Where the data is valuable

  • Reports of PPE shortages:
    • Providers are asked to self-report a lack of important supplies to care for COVID-19 patients. In the last week of May, 3,998 SNFs reported new COVID-19 cases in their facility. Among these providers, 2% reported not having adequate testing, 2% did not have gowns, 1% did not have access to masks, 1% lacked eye protection and 1% did not have hand sanitizer. While only a small percentage of providers in the US are self-reporting this lack of key supplies, it is helpful to know which providers are struggling to access these critically-needed items.
  • Reports of Staffing shortages: Providers are also asked to report on staffing shortages based on current casemix and census. Approximately 19% of providers, who also reported new COVID-19 positive cases in their facility the last week of May, reported not having staff required to meet internal policies on staffing ratios.

Both of these data points are helpful in determining which providers are well equipped to care for patients during the COVID-19 pandemic. Overall, CMS’s first release of COVID-19 data in individual nursing homes is useful, but should be used with caution.

To learn more, including which aspects of CMS’s data may be more useful, watch CarePort’s recent webinar.

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