Nursing homes still face data woes
Post-pandemic audit says Department of Health has made ‘limited progress’
ALBANY — The state Department of Health largely failed to implement recommendations meant to improve infection control in nursing homes, according to an audit released by the state comptroller’s office on Wednesday.
The audit came as a follow-up to a March 2022 audit by state Comptroller Thomas Dinapoli’s office that found data released by the Health Department “misled the public” and undercounted deaths in nursing homes. The report made four recommendations to the Health Department and one to Gov. Kathy Hochul’s Executive Chamber to improve the use, collection and reporting of infection control data.
The follow-up audit said that the Health Department and Executive Chamber both made “limited progress in addressing the problems we identified in the initial audit report.” Concerns with how nursing homes handled the pandemic in New York have continued to be analyzed, with many lawsuits still active.
Of the four recommendations made, the audit found that one was implemented, one was partially implemented and two were not acted on. The recommendation made to Hochul’s Executive Chamber was partially implemented.
The first recommendation to the Health Department called for expanded use of infection control data to identify trends and areas of concerns in nursing homes to improve policies. The department was also asked to improve the quality of publicly available nursing home data, strengthen communication and coordination with local communities and collect and incorporate data from additional sources into their system.
The state comptroller’s office found that while they improved public data, they did not provide any supporting documentation to back up claims that they were working on implementing systems to meet the other goals.
The Health Department was found to have implemented the original audit’s recommendation that the department evaluate and request resources to prepare for a public health emergency, the state comptroller’s office said.
That effort included adding resources and an additional 74 positions, including data analysts and health care surveyors, 55 of which have been filled. The new roles also include eight pending hires and 11 vacant positions.
Dinapoli’s office also sent the department recommendations to provide guidance to nursing homes to ensure accurate data submission, which the audit said was not implemented.
“By not taking action to implement this recommendation, there is a good chance that the department is collecting, reporting on, and/or analyzing data that is, at times, inaccurate, inconsistent or incomplete,” the follow-up audit said.
The final recommendation to the Health Department is for it to develop processes to improve controls over data included on the Centers for Medicare and Medicaid Services database to ensure reliability. The state comptroller’s office said that the recommendation was not implemented.
The report said that department claimed that the procedures in place prior to the original audit were effective, but auditors said that when comparing data on the Health Department’s Open Data website to the CMS website for a sample of 25 nursing homes, 88 percent were found to have discrepancies.
The audit also reported that Health Department officials said they entered data accurately to the CMS system and had no control over what the federal system accepted or subsequently edited.
“While a few minor discrepancies may be understandable, the significant number of discrepancies in the citation data indicates that there is a larger problem,” the state comptroller’s audit said. “By not taking action to implement this recommendation the department is not ensuring that all publicly reported data is reliable.”
The 2022 audit also made a recommendation to the Executive Chamber to ensure that the Health Department’s “control environment” is adequate, including making sure there is communication with localities, cooperation with state oversight inquiries and use of external reporting.
The state comptroller’s office reported that the Executive Chamber successfully ensured that the Health Department posted “key data” to New York’s Open Data website, along with implementing a “transparency plan” to post more information that is commonly requested with Freedom of Information Law requests.
The Executive Chamber also worked with the Legislature and localities to make changes to the Health Department’s previous leadership from former Gov. Andrew M. Cuomo’s administration to address concerns with their reporting of COVID-19 data. Cuomo came under fire in 2021 in a report by state Attorney General Letitia James that found nursing home deaths were underreported by as much as 50 percent during the height of the pandemic.
The audit said that the Executive Chamber did not show documentation supporting that they had ensured the adequacy of the health department’s control environment, deeming the recommendation “partially implemented.”
“We’ve changed the culture,” Hochul said at a news conference Wednesday. “We’ve changed the environment and are very focused on, not just health care institutions overall, but really, laser focused on our nursing homes where we take care of the most vulnerable in our state.”
Hochul also said that more than 10 years of “disinvestment in all facets of health care” had led to concerns.
The governor said that she also raised Medicare reimbursements by 7.5 percent after a decade of flat payments.
“We’ve invested in our health care workforce. We gave bonuses to people last year,” Hochul said. “But also, our Department of Health, the agency charged
with overseeing our nursing homes, was basically starved to death.”
The Health Department said in a statement that Hochul’s administration has taken steps to expand the information publicly reported on fatalities.
“We appreciate the comptroller’s recommendations, including other actions to strengthen data tools and processes that are completed, underway, or being addressed,” the Health Department said in a statement.
“The lessons learned from the COVID pandemic continue to inform us, as we remain well-prepared for any new COVID outbreaks or future pandemics.”