Since July 1995, nearly 10% of all nursing homes in California were found by state and federal investigators to have serious quality deficiencies for two straight years, but only a quarter of those were ever sanctioned by HCFA, according to a report released last week.
The General Accounting Office report led to accusations by lawmakers that HCFA had been hoodwinked by nursing homes.
The GAO undertook the study at the behest of Sen. Charles Grassley (R-Iowa), chairman of the Senate Special Committee on Aging. Grassley said HCFA has been "taken to the cleaners" by nursing homes that took advantage of HCFA's policy of allowing facilities a grace period to correct deficiencies.
According to the GAO, nursing homes routinely use the 30- to 45-day grace period to make temporary changes to satisfy regulators' concerns, only to revert to their old ways after the regulators leave. The GAO found that only 16 of the nearly 1,400 nursing homes in California were terminated from Medicare or Medicaid since 1995, even though 30% of the homes were found to have deficiencies that "caused death or serious harm."
"If there's one responsibility HCFA has, it's to ensure that states are doing their job," Grassley said. "HCFA's been asleep at the switch."
Lawmakers view the California results as an indication that the same problems exist nationwide.
HCFA Deputy Administrator Michael Hash took issue with Grassley's assessment. "Our approach has been to try to work with (the nursing homes) that have deficiencies in order to bring them into compliance," Hash said.
Overall, the GAO found the state and federal oversight of nursing homes to be largely ineffective. The GAO recommended a number of changes, including random quality checks, rather than the current system of site visits, which the GAO said nursing homes can predict.
Hash said HCFA plans to increase scrutiny of nursing homes and take quicker action against those with poor quality. A week before the GAO report was released, the White House unveiled a series of nursing home quality initiatives in an effort to head off criticism of its oversight.
But in a separate report also released at last week's hearing, Andrew Kramer, M.D., research director for the University of Colorado Health Sciences Center, studied two California nursing homes at the same time the facilities were being reviewed by the state. Using the same criteria, Kramer found numerous deficiencies at both sites, most of which were not found by state inspectors. In fact at one facility, the state found no deficiencies at all.