We can thank researchers at the University of Chicago for the latest whack at the piñata better known as the nursing home industry.
Last week, in JAMA Network Open, they reported that many facilities are under-reporting resident falls and bedsores. The clear implication here is that consumers and others tapping into the Care Compare website may be getting flawed information.
Over six years, 40% of hospitalizations related to major fall injuries that were found in hospital claims were not reported in facility-level Minimum Data Sets, the researchers found. For pressure ulcer hospitalizations, a third went unreported during the same stretch.
The findings are based on records from more than 13,000 nursing homes. According to the report, it wasn’t just a few bad apples spoiling the barrel. Roughly 7-in-10 facilities reported less than 80% of their patients’ fall and pressure ulcer hospitalizations.
“Underreporting of clinical events to CMS was widespread during the study period,” wrote lead author Prachi Sanghavi, PhD, an assistant professor at University of Chicago. “Although CMS appears to recognize this situation, as evidenced by the lower weighting of quality measures in the ratings, the measures remain on public display. In other words, the quality measures are in limbo, but the public may be using these measures to make important life decisions.”
Industry reaction to the report was about what one would expect. The study’s methods and conclusions were immediately challenged.
“Nursing homes are committed to accurate reporting of quality measures, and this flawed study does not represent what’s happening today. Additionally, nursing homes have made dramatic improvements on all quality measures over the past decade and continue to focus on improving the quality of life for our residents,” the AHCA/NCAL said in a statement.
Can it be true that injury underreporting is taking place and that the industry is committed to delivering better care than ever? Of course. Actually, it’s probably safe to say both assertions are valid.
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
Upton Sinclair
What this report actually reveals is a deeper problem: industry self-reporting of bad news.
Let’s face it, none of us likes to showcase or even admit to our shortcomings. So it’s only human nature to downplay or even overlook things that are less than flattering. For evidence, I point to every dating app in the universe.
Should it be terribly surprising that any person or business might fudge a bit when given the opportunity to do so? Hardly.
No, the real problem here is that it should not be facilities reporting these numbers in the first place.
That’s not to say that better solutions will be easy to put in place. If they were, CMS surely would have already done so.
But until such information can be obtained from an objective source, we would do well to keep an old adage about data collection in mind: Garbage in, garbage out.
John O’Connor is editorial director for McKnight’s.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
