If deficiencies don't measure quality of care, what do they measure? A recent study by a nursing home industry analyst argues that they simply reflect surveyors' biases.
Advest analyst Rob Mains and associates ran a statistical analysis of HCFA data to test whether the number and seriousness of deficiencies could be used to differentiate among homes owned by six of the largest publicly held nursing home chains.
The answer: They can't.
The researchers from the financial services firm assigned points to each deficiency depending on its degree of seriousness. They then looked at how homes owned by the six chains fared across 12 states.
The researchers reasoned that quality standards at individual homes should be tied to chainwide policies. If quality could truly be measured based on deficiencies, differences at chains should hold up across state lines.
They found instead that the variations in deficiency scores were much more closely tied to location than to ownership. The best predictor for a home's score was not its ownership but whether it was located in states such as California or Florida, where the researchers said surveyors took a harder-line approach. Nursing homes in such states scored worse overall.
Ironically, some state surveyors agree that deficiency scores can be misleading.
In 1998, average deficiency scores in Nevada were higher than in any other state. Rick Panelli, the chief of the Nevada state health department's bureau of licensure and certification, points out that nursing homes in his state have not had the headline-making problems that homes in other states have had. "A part of that is (our) critical oversight," he said. "I would put up our long-term-care facilities against any in the country."