Number of Health Revisits during Nursing Facility Health Inspections
One of the criteria that an overall rating for nursing facilities covers is health inspections. Performance in this domain is measured by using the deficiencies found during the three most recent annual state health inspection surveys, discoveries from the most recent 36 months of complaint investigations and focused infection control surveys, and the number of revisits required to rectify any deficiencies identified during the health inspection surveys. We will be looking at the number of revisits for nursing facilities in the United States that are Medicaid and/or Medicare providers.
Health Surveys and the Number of Revisits
A health inspection score is calculated by assigning points to deficiencies and the number of revisits. The number of points assigned depends on the severity of the deficiencies with additional points added based on the substandard quality of care. The lower the score, the fewer the deficiencies and revisits a facility has. A lower score thus indicates better performance in the health inspection domain. The Centers for Medicare and Medicaid Services (CMS) calculates a total weighted health inspection score over three rating cycles. The most recent period, rating cycle 1, is given the biggest weighing factor of ½; rating cycle 2 is given a weighting factor of ⅓; and rating cycle 3 is given a weighting factor of ⅙. These individual weighted scores from each rating cycle are then summed to create the total weighted health inspection score.
Points are only assigned for the 2nd, 3rd, and 4th revisits. These additional revisit points can make up to 85 percent of the health inspection score by the 4th revisit, as more revisits indicate serious quality problems. We will be looking at how many nursing facilities in the United States from our dataset had 0, 1, 2, 3, and 4 revisits in all three rating cycles.
Figure 1: Number of US Nursing Facilities with Different Numbers of Health Revisits
It appears that in all three rating cycles most nursing facilities had one health revisit, which does not add any additional points, and less than 2000 nursing homes required any revisits after their first revisit (if they received one). Percentages of how many nursing facilities had each number of revisits were calculated for each rating cycle and the average of those values are displayed in the following table.
Figure 2. Average percentage of Nursing Homes with Varying Number of Revisits
A very low percentage of nursing facilities needed four revisits in one rating cycle. Findings used to construct a health inspection score are taken from the most recent 3 health inspection surveys, and nursing facilities are supposed to be inspected every one to two years. The following pie chart displays the nursing facilities that have followed this guideline. CMS halted routine inspections due to COVID-19 to prioritize the pandemic and its effects, and declared in August 2020 that they would resume routine inspections. This may be part of the reason why we have 20% of nursing facilities without a recent inspection. Despite the uncertainty in assessing the performance of a nursing facility due to the possibility of not having a recent inspection, the nursing facilities seem to do well in terms of maintaining a low number of revisits during survey cycles.
Figure 3: How Many Nursing Homes had a Health Inspection in the Last 2 Years
By Beatrice Ling