CMS star ratings don’t indicate COVID-19 cases, deaths, data show

A nursing home’s overall CMS star rating does not correlate directly to its COVID-19 caseload or related deaths, according a Modern Healthcare analysis of federal data.

CMS on June 1 said that “early analysis shows that facilities with a one-star quality rating were more likely to have large numbers of COVID-19 cases than facilities with a five-star quality rating.” However, CMS on June 4 explained that nursing homes with the largest outbreaks were those with lower inspection ratings.

“For example, when looking at nursing homes at the 90th percentile in terms of COVID-19 cases and deaths, facilities with a five-star rating were less likely to have high numbers of COVID-19 cases or deaths than facilities with a one-star rating. This means that facilities with a poor compliance and inspection history were more likely to have larger COVID-19 outbreaks,” CMS said. CMS stressed that this was a preliminary analysis.

In aggregate, when factoring in bed occupancy, there is a slight trend—a 1.5 percentage point difference in average cases between facilities with one- and five-star quality ratings—showing that facilities with lower ratings are more likely to have higher numbers of COVID-19 cases among residents than nursing homes with higher ratings, according to a Modern Healthcare analysis. However, when you add in staff cases as well, the overall trend line is less distinct between highly-rated and lower-rated facilities.

The government data, however, has limitations and CMS Administrator Seema Verma urged the public to “use caution when interpreting data in this early stage.” There are “honest errors in data entry” as nursing homes learn how to submit the data, and CMS is working on quality control, she said.

CMS first started requiring nursing home to submit information on COVID-19 cases and related deaths last month in order to provide standardized information on nursing homes across the country.

Many nursing homes have complied with the data requirements, with 88%—or 13,600 —of facilities submitting data as of May 31. They recorded more than 95,000 confirmed cases of COVID-19, another 58,000 suspected cases and nearly 32,000 deaths, CMS said. That data excludes assisted living facilities.

New data will be shared next week, and then the releases will become weekly. Demographic information is not being collected.

“I think CMS ideally should have been collecting this data from the very beginning,” said David Grabowski, a professor of health care policy at Harvard Medical School. “When we had everything happening in in Europe, it was pretty clear things were going to hit nursing homes hard. Not to even try to collect the data until May was a huge mistake. It prevented us from really learning from our early successes and failures.”

While states were collecting and sharing nursing home COVID-19 data, they were all doing so differently, Grabwoski said.

Without that national database, the U.S. “lost the opportunity to learn in real time,” Grabowski said. “We’ll never get that opportunity back.”

The case information submitted by facilities will be used both to inform the public and in CMS’ enforcement of infection control deficiencies in nursing homes.

Grabowski said he doesn’t think more regulation and oversight is the best response. Instead, ensuring that all facilities have access to testing, personal protective equipment and safety resources would be more effective, he said.

“I’m not at all convinced that directing more oversight to one-star facilities is actually going to save lives. What’s going to save lives is investing in resources across the spectrum,” Grabowski said.


Tags: covid-19, pandemic

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