Nursing Homes Underreport Problems on Certain Quality Measures: Analysis

Self-reported nursing home data for three key quality metrics does not line up with subsequent hospital diagnoses, a new analysis of public data has concluded — with one category, pressure ulcers, showing direct evidence of underreporting, according to the report.

More than half of skilled nursing facilities underreport the prevalence of pressure ulcers by a factor of two, the report from Integra Med Analytics determined.

Source: Integra Med Analytics

The Austin, Texas-based Integra Med Analytics routinely performs forensic analyses of public health care data with the goal of preventing fraud and abuse.


This most recent project compared self-reported data from the nursing home Minimum Data Set on pressure ulcers, urinary tract infections (UTIs), and falls against hospital-generated records for residents who were readmitted; to eliminate conditions that may have developed during the hospital stay, the researchers only counted problems listed as “present on admission.”

While Integra only concluded that there was direct evidence of underreporting on the pressure ulcer metric, the firm found that there was no correlation between the SNF and hospital reporting for any of the three.

“SNFs with low self-report rates may have high hospital-based rates and vice-versa,” Integra observed. “For example, a SNF home we analyzed had a low self-reported UTI rate of less than 1 in 1,000 which is in the first percentile of the self-reported rates. However, 5.8% of this SNF’s admissions were re-hospitalized with a UTI, which is in the 86th percentile for the hospital-based measure.”


The analysis did not attempt to ascribe motive to underreporting among nursing homes, noting that facilities have an incentive not to disclose negative data — but also adding a hypothesis that some pressure ulcers may have simply gone unnoticed.

“If that hypothesis were true it would still be a matter of concern even if the under-reporting was not systematic or intentional,” Integra observed.

The report comes as the media and resident advocates have scrutinized self-reported tallies of COVID-19 infection and death rates in nursing homes.

Facilities have been required to submit the information to the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control & Prevention (CDC) since May. But those figures — as well as those collected separately by state and local authorities — have been subject to wide variances in timeframes and even definitions of what counts as a nursing home death from COVID-19.

“Nursing home quality has come under increased scrutiny recently due to the large number of COVID-19 related deaths in nursing homes and the CMS quality measures have been used for Senate testimony and academic research,” Integra wrote. “However, concerns over the accuracy of these quality measures are widespread and critiques come from government reports, media articles and academic research dating from at least 2001.”

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