On March 4, 2020, the Centers for Medicare & Medicaid Services (CMS) suspended non-emergency inspections of health care facilities in response to the COVID crisis.[1] On March 20, CMS limited surveys to two types: targeted infection prevention and control surveys and complaint/facility-reported incidents triaged as immediate jeopardy.[2] CMS released the results of targeted infection control/ immediate jeopardy surveys on June 4, June 24, and July 29. Each release was cumulative, reflecting all of the targeted infection prevention and control surveys to date since March.
Today, the Center releases three reports: two cumulative reports, one for June 24 and the other for July 29, as well as the results of a separate CMS database that includes infection control data, QCOR. (Earlier, the Center issued reports on the surveys released June 4 and the non-cumulative surveys released June 24.[3]) Twenty facilities cited with immediate jeopardy deficiencies since March 2020 appear on both the July 29 cumulative list and QCOR.
Targeted Infection Control Surveys
July 29 Data Release
Since March, and as reported on July 29, CMS has conducted 16,987 targeted infection prevention and control surveys and complaint/facility reported incidents triaged as immediate jeopardy. As a result of these 16,987 surveys, CMS cited 347 infection control deficiencies at 342 facilities. Analysis of the cumulative data documents that only a very small fraction of the surveys, 2.0%, resulted in a deficiency for infection prevention and control and 93.4% of the deficiencies were classified as “no harm” or “substantial compliance,” the two lowest levels of noncompliance for which financial penalties are rarely imposed.
Compared to the earlier cumulative release (June 4 and June 24), the July 29 release shows that a smaller number and percentage of reported surveys led to an infection control deficiency, but that a larger (although still small) percentage of those deficiencies were classified as immediate jeopardy, the highest level of noncompliance assigned to less than 1% of deficiencies.
| Date of CMS release | Total number of surveys reported | Total number/percent of infection control deficiencies cited | Total number/percent of immediate jeopardy deficiencies cited |
| June 4 | 5,724 | 163 (2.8%) | 1 (1.0%) |
| June 24 | 9,899 | 262 (2.6%) | 4 (1.5%) |
| July 29 | 16,987 | 347 (2.0%) | 22 (6.6%) |
June 24 Data Release
The Center for Medicare Advocacy reviewed the star ratings for the 260 facilities that were cited with 262 infection prevention and control deficiencies, according to the June 24 release of 9,899 surveys. More than 60% of the facilities had one or two stars in health inspections (on a five-star scale, with five being the highest) and nearly half had one or two stars in staffing as well. Facilities scored well only on the self-reported quality measures domain; more than 55% had four or five stars in quality measures. Finally, facilities cited with infection prevention and control deficiencies were more likely than facilities that were not cited with such a deficiency to be operated on a for-profit basis, to have had the remedies of civil money penalties or denial of payment for new admissions imposed in the prior three years, and to be Special Focus Facilities or candidates for the Special Focus Facility program.
QCOR
The targeted infection control surveys identified on Nursing Home Compare are not the entire story. CMS has a separate database, qcor.cms.gov, that also includes information about nursing facilities, among other health care providers. The Center looked at QCOR on July 24 and searched for infection prevention and control deficiencies, at the immediate jeopardy level, that were cited since January 2020 (QCOR reports data by calendar year or fiscal year).
Analyzing the 29 facilities that were cited with 31 infection prevention and control deficiencies since March 2020, the Center found that 21 of the deficiencies were cited as immediate jeopardy.
On Nursing Home Compare, these facilities performed extremely poorly: 85.7% had one or two stars in health inspections and 67.8% had one or two stars in staffing. In addition, 62.1% had had civil money penalties imposed and seven were Special Focus Facilities or candidates (24%). Ninety percent for were for-profit facilities.
Conclusion
Although it is not clear why separate CMS databases identify different information about infection prevention and control deficiencies, the limited number of deficiencies identified in both CMS databases is not believable, when this deficiency has been the most frequently cited deficiency[4] and when the country is experiencing a pandemic in which nearly half the deaths in the country (and more in some states) are nursing home residents.
- To read the full report, Infection Control Surveys at Nursing Facilities Reported Released by CMS in June 2020: Few Deficiencies, Most Called “No Harm;” Poor Ratings on Nursing Home Compare, please go to: https://medicareadvocacy.org/wp-content/uploads/2020/08/Special-Report-Infection-Control-Cumulative-6.24.20.pdf
- To read the full report, Special Report Infection Control Surveys at Nursing Facilities Reported Released by CMS in July 2020: Few Deficiencies, Most Called “No Harm,” please go to: https://medicareadvocacy.org/wp-content/uploads/2020/08/Special-Report-Infection-Control-Cumulative-7.29.20.pdf
- To read the full report, Infection Control Deficiencies in Nursing Facilities: QCOR Data, please go to: https://medicareadvocacy.org/wp-content/uploads/2020/08/Special-Report-SNF-Infections-QCOR-Data.pdf
Aug. 6, 2020 – M. Edelman, MPA, MSSW, T. Edelman
[1] CMS, “Suspension of Survey Activities,” QSO-20-12-All (Mar. 4, 2020), https://www.cms.gov/files/document/qso-20-12-all.pdf.
[2] CMS, ‘Prioritization of Survey Activities,” QSO-20-20-All (Mar. 23, 2020), https://www.cms.gov/files/document/qso-20-20-all.pdf.
[3] On June 4, 2020, CMS released infection control survey data for 5724 nursing facilities that were conducted during the COVID-19 pandemic. These data showed a dramatic and implausible decline in infection control deficiencies. Less than three percent of infection control surveys since March cited an infection control deficiency and 161 of 163 of the deficiencies (cited in 162 facilities) were classified as causing residents “no harm.” The Center for Medicare Advocacy issued two reports about these 163 infection control deficiencies. CMA, “Special Report: infection Control Surveys at Nursing Facilities: CMS Data are Not Plausible” (Jun. 11, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/06/Infection-Control-Surveys-Report.pdf.; CMA, “Special Report: Nursing Homes Cited with Infection Control Deficiencies during the Pandemic: Poor Results in Health Inspections, Low Staffing Levels” (Jun. 18, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/06/Coronavirus-Report-Infection-Control-Deficiencies-NHC.pdf.
[4] Jordan Rau, “Infection Lapses Rampant In Nursing Homes But Punishment Is Rare,” Kaiser Health News (Dec. 22, 2017), https://khn.org/news/infection-lapses-rampant-in-nursing-homes-but-punishment-is-rare/.