When the administrator of the Saugus Rehab and Nursing Center in Saugus, Massachusetts, heard that a new Medicare
website
reported her facility had 794 confirmed cases of COVID-19 — the second
highest in the country — and 281 cases among staff, she gasped.
“Oh my God. Where are they getting those numbers from?” said Josephine Ajayi. “That doesn’t make any sense.”
Those weren’t the numbers that her facility reported to the CDC’s
National Healthcare Safety Network, under new rules from the Centers for
Medicare & Medicaid Services (CMS), she said.
Ajayi said her 80-bed facility actually reported 45 residents have
tested positive and five residents died, although the CMS website showed
no Saugus deaths. About 19 staff members tested positive for the virus,
and most have returned to work, she said.
Officials at skilled nursing facilities around the country said
Monday they were shocked to see their data reported inaccurately —
wildly so in some cases, as at the Saugus home — on the new CMS public
website
launched Thursday.
The numbers are scaring families, harming their reputations, and in
some cases are physically impossible, given the number of beds or staff
in their facilities, they said.
CMS approved an interim final rule May 1 requiring more than 15,000
nursing homes receiving Medicare or Medicaid reimbursement to report
COVID data by May 31, and weekly going forward.
The data fill 56 columns detailing COVID-19 infected residents,
staff, testing, and equipment, going back to at least May 1. As of
Thursday, CMS said 88% of the nursing homes in the country had reported.
Going forward after a grace period ended June 7, they risk fines of
$1,000 and up for every week they fail to update their data.
But in many cases, nursing home officials said their data were
somehow scrambled, either because nursing home personnel reported in the
wrong columns, or the numbers were loaded incorrectly somewhere between
the CDC and CMS.
For example, Southern Pointe Living Center in Colbert, Oklahoma, with
95 beds, was reported to have had 339 residents die of COVID-19, yet no
confirmed or suspected cases.
“We have not lost anyone nor have we had a [COVID-19] case in the
building,” said a woman identifying herself as an assistant at Southern
Pointe but who declined to give her full name. The day after CMS
released the data, on Friday, she said someone from the CDC called the
facility to ask if their numbers were correct as reported, “and we told
them no.”
She added, “I don’t know how that happened but that is an error on
their end.” As of Tuesday morning, the posted data had not been
corrected.
“Insanely wrong”
MedPage Today first learned of the inaccuracies shortly after
publishing an article Friday
on the new public database. In that article was a list (since removed)
of “outliers” — those with the highest numbers of cases and deaths among
residents and staff — that included Dellridge Health and Rehabilitation
Center in Paramus, New Jersey. The CMS data indicated it had the most
COVID-19 deaths of any nursing home in the country at 753.
That number is “insanely wrong,” Jonathan Mechaly, Dellridge’s
marketing director, wrote in a frantic email. “We are a 90-bed center
and have had less than 20 deaths!! How do you report such inaccurate
numbers?”
After a download of the data, a quick sort of the columns easily
reveals extreme totals in various categories. But no one called those
nursing homes before the data were released to doublecheck, for example,
when 100-bed Smith Village in Chicago was shown to have 1,105 confirmed
COVID-19 cases among residents and 955 confirmed COVID-19 cases among
staff, the most in the country.
“We apparently misread the instructions, which were not very clear,”
Yahaira Ramirez, Smith Village’s director of clinical operations told
MedPage Today.
The facility has had only 38 positive cases among residents and 14
deaths, and among staff, 37 positive or suspected cases but no deaths,
she said. But instead of showing up as a total, those numbers somehow
appeared as if there were additional cases every day in May. No one
caught the error.
It would have been helpful if someone from either agency had at least
checked on the highest outliers before publishing, Ramirez said. “We’ve
been trying to abide by a lot of the guidelines (from) CMS and CDC, but
it’s been challenging. You talk to different people and you get a
different answer. Unfortunately, I’m not surprised that they haven’t
reached out.”
Asked why there appeared to be so many errors in the data, a CMS spokesman emailed this response:
“As with any new reporting program, there can be data submission
errors in the beginning. In an effort to be transparent, CMS made the
data collected by the CDC public as quickly as possible balancing
transparency and speed against the potential of initial data errors.”
“CMS is advising nursing homes when their submitted data has not
passed certain quality checks so they can review the CDC submission
instructions and their data submission for accuracy. As CMS continues to
analyze the data going forward we expect fewer errors as nursing home
staff get used to these requirements and CMS has more time to quality
check the data.”
Asked why CMS, at the very least, did not contact the highest
outliers, for whom such large numbers of COVID-19 cases or deaths were
highly unlikely because of their size, the spokesman did not respond.
It’s also true that CMS Administrator Seema Verma, in announcing the
database’s launch, told reporters on a phone call that it would probably
include inaccurate data.
Destroying family trust
Paula Sanders, an attorney in Harrisburg, Pennsylvania, who
represents some 200 skilled nursing facilities, said many of her clients
“can’t figure out where these numbers are coming from” and have been
“frustrated” in trying to get them corrected since Thursday.
“This has destroyed the trust between the facilities and the
families, because they’ve been reporting and telling the families, these
are our numbers,” Sanders said. “Then these numbers come out and don’t
make any sense at all. Unfortunately, some families are going to believe
the government over the facilities.”
Sanders, who is on the legal committees of two nursing home advocacy
groups, the American Health Care Association and LeadingAge, said within
the two federal agencies, “there was such a rush to get these numbers
out that there was no quality control. You’d think the government would
say, ‘yes, we want to absolutely make sure the data we’re providing is
correct, because the reputation [is in jeopardy] for the facilities if
we’re wrong.'”
“But they weren’t doing that. The amount of time these facilities
have spent away from patient care trying to respond to questions from
reporters or family over meaningless numbers…it’s a shame. It’s just a
shame.”
Adding to the confusion, Sanders said, was the CMS rulemaking process
regarding reporting requirements and directions, which seemed to change
even after facilities started submitting.
Sometimes the fault was admittedly that of the facilities. The CMS
website showed that 92-bed Robison Jewish Health Center in Portland,
Oregon, had eight staff members die of COVID-19. In fact, they had no
deaths. Administrator Krista Mattox said the problem was their own data
entry error, “but it caused ripples through our Oregon state licensing
office.”
It would have been nice if either agency had sent an email
notification showing how their data would show up, but that didn’t
happen.
Karl Steinberg, MD, president-elect for the Society for Post-Acute
and Long-Term Care Medicine, said it’s “highly improbable that nursing
homes would make such mistakes in their data, for example, making the
numbers of deaths higher than they actually were.”
He added that the whole effort to demonize COVID-19 cases in nursing
homes is wrong-headed and counterproductive. “Seema Verma has pretty
much said we’re going to slam these facilities, bring the hammer down
hard. But to conflate quality of care in a facility with the number of
cases is horrific” especially since in some parts of the country,
nursing homes were required by their state governments to accept
COVID-19 patients.
“I think they’re just trying to scapegoat and lay blame on the
facilities,” said Steinberg, medical director of a San Diego area
hospice. “Certainly some could have done better, but in a lot of cases
they were like sitting ducks.”
https://www.medpagetoday.com/infectiousdisease/covid19/86967
