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Why the Latest GAO Report Reinforces Need for Survey Reform

by Published On: Aug 19, 2011

The Government Accountability Office (GAO) recently released a report titled, “Private Investment Homes sometimes Differed from Others in Deficiencies, Staffing, and Financial Performance.”

Many of you have seen some press and have asked if this is a relevant study and how does it apply to us. I would summarize this report as follows: “When you take a small sector of one part of a business and find that there are some differences in some situations, what have you really told me?”

This report was limited to private investment homes, which are not to be mistaken for “The Chains,” nor are they the publicly traded companies, and are certainly not the scope of the for-profit sector.

Furthermore, the conclusions were that there were “some differences in deficiencies, staffing and financial performance,” but “did not differ significantly from non-profit homes in the likelihood of a serious deficiency when controlled for other explanatory factors.” Thus, the college notes version of this study might read that “some homes had some differences in some areas, but overall there were no significant differences concluded.” 

One might read deeper and challenge the methodology and how the data was captured to analyze potential differences. Since this report relied heavily on the OSCAR reports, one basic flaw is the remarkable variation in survey process itself: both the identification of deficiencies, as well as their assigned scope and severity.

As noted in the report “Broken and Beyond Repair,” lead by LeadingAge, the current survey process for nursing homes is driven by a complex punitive structure that is highly inconsistent across survey teams and across regions of the country.

So, while the press tried to grab on this title and make sweeping conclusions that just were not there, perhaps we can use this opportunity to push back to the GAO and to Congress that we truly need survey reform.

We need an Institute of Medicine report to guide a re-examination of our current system and provide recommendations for improvement. Then, perhaps, we can use such GAO reports to truly describe variation and let us articulate our not-for-profit difference!  


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