Regulators to review nursing home deaths
Federal regulators will review the official tally of COVID-19 deaths at one of the nation’s largest nursing home chains after the company cut its reported death toll by an unprecedented 42% following a USA TODAY investigation.
Presented with USA TODAY’s findings that Trilogy Health Services had the worst death rate among its peers during last winter’s coronavirus surge, company officials said they discovered they had included deaths in their mandatory weekly reports that should not have been counted.
On Thursday, a chief medical officer at the Centers for Medicare and Medicaid Services called the resulting changes “concerning.”
“CMS takes reports of data inaccuracy very seriously and will hold any bad actors accountable,” Dr. Lee Fleisher, the agency’s director of clinical standards and quality, said in an emailed statement.
The Midwest chain originally reported 772 deaths at 113 facilities from October 2020 through February 2021. The cut of 325 deaths, which the company said is based on federal guidance, drops its reported rate from highest to third-highest among the nation’s 10 largest nursing home chains.
Even more deaths could be excluded from the official tally for Trilogy, which operates homes in four states: Indiana, Kentucky, Michigan and Ohio.
Trilogy plans to submit another revision to its data for dozens more weeks beyond those analyzed in USA TODAY’s investigation.
Damon Elder, a spokesman for American Healthcare REIT – the real estate investment trust that owns Trilogy facilities and shares in company profits – said Wednesday that he did not know the scale of those additional changes.
The revisions submitted by Trilogy deleted as many deaths as had been removed by a combined 13,500 other facilities. No other chain came close.
Most large chains that revised their numbers added deaths, according to a USA TODAY analysis of the data posted on the CMS website.
Last week, CMS spokesperson Mark Brager said the agency’s policy is to accept revisions to self-reported COVID-19 case data without explanation or review.
This week, Fleisher clarified that the agency would review Trilogy’s changes.
Federal rules adjusted for the pandemic allowed facilities to charge a higher rate for people with COVID-19 who were treated at the nursing home instead of being transferred to a hospital.
Asked whether the company’s revised accounting of COVID-19 cases and deaths would be compared to Medicare and Medicaid bills paid by CMS on behalf of residents, Fleisher described “some challenges” but did not specify whether such a review would take place.
While data was used to monitor cases and deaths in real time, it did not include the names of people counted, making it difficult to match with federal billing records that are tracked in a separate system.
Elder said Trilogy has not been contacted by either CMS or the Centers for Disease Control and Prevention about its revisions. Since late May 2020, CMS has required facilities to submit weekly reports of new COVID-19 cases and deaths to the National Healthcare Safety Network (NHSN), a database run by the CDC.
The government has used the information to award billions of dollars in COVID-19 aid as well as direct resources to support facilities with outbreaks.
Some academic researchers, who have relied on the data to study how and why COVID-19 has killed more than 140,000 people in nursing homes, called on government officials to step in after learning of Trilogy’s extensive revisions.
David Grabowski, a health care policy professor at Harvard University medical school who studies nursing home performance, called Trilogy’s revisions “suspicious.”
Grabowski said there “should be some consequences” for submitting incorrect data to the NHSN because of how important the system is to government officials and researchers who use it to understand the pandemic.
“Either they are admitting they submitted bad data or they are going back and altering the data to make themselves look better,” he said.
“I don’t like either of those outcomes and both of them speak to the need for increased oversight and accountability.”
Charlene Harrington, who has studied nursing home quality for more than four decades, agreed that CMS should thoroughly investigate.
“I really don’t see why CMS would let nursing homes revise their reports without some specific evidence that documents the information,” said the professor emerita at the University of California, San Francisco.
A report from the inspector general of the U.S. Department of Health and Human Services, which examined the early days of the federal reporting, found the majority of nursing home submissions appeared complete.
An updated evaluation is due to be published in September.
Federal regulators “should be asking questions” about significant revisions, such as the one made by Trilogy, said Karen Shen, a Harvard Ph.D. candidate who led a study estimating at least 16,000 people died in nursing homes before mandatory reporting.
Another person hoping for government action after Trilogy’s revision: Shana Driver, whose mother died in a Trilogy-owned nursing home in Indiana last winter.
A 103-degree fever suggested and two positive tests confirmed Sue Miller had COVID-19, Driver said, remembering what she learned during conversations with nurses. Two weeks later, the family was approved for final bedside visits inside the COVID-19 ward.
Miller died on Day 4 of their vigil, Dec. 21, 2020, while her son-in-law sat at her bedside playing her favorite Bee Gees songs.
Sue Miller’s death certificate lists COVID-19 pneumonia as the cause of death.
Originally, Trilogy reported four deaths that week, all from the pandemic virus. Its revised data shows none.
“I don’t know how they can just erase that,” Driver said. “That just makes me angry. … They are just trying to erase people.”