Mixed Bag: CMS Reports How Nursing Home Quality Measures Fared During the Pandemic

Health care settings, including the nursing home sector, performed worse than expected for about half of the federal government’s quality measures during the Covid-19 pandemic, although key measures such as rehospitalization rates for short-stay residents did surprisingly better, the Centers for Medicare & Medicaid Services (CMS) reported Wednesday.

Overall, the pandemic had major impacts on various quality measures’ performance, with 38% of the measures performing worse in 2020, while 47% having worse-than-expected performance in 2021. In some cases, the pandemic reversed the gains seen leading up to the pandemic, the report found.

Of the measures that did improve, potentially preventable readmissions in post-acute care settings did 0.5 to 2.7 percentage points better in 2021 compared to the federal agency’s baseline, one set by data collected between 2016 to 2019. Hospitalizations of nursing homes and home health patients were 0.7 to 1.5 percentage points better, comparing the baseline to 2021 data.


CMS published these findings in its 2024 National Impact Assessment of Quality Measures report.

The federal agency also acknowledged that this latest report is a snapshot of a unique time in history, and the lingering impact of the pandemic on the resilience of the health care system remains to be seen. The agency’s report on the performance of the measures related to this for the post-pandemic period will examine data past 2021 and is forthcoming. 

In terms of falls with major injury, the report found that skilled nursing facility rates improved between 2017 and 2019, but were worse than expected in 2021. Meanwhile, no SNF fall data was available for 2020, according to the report.


“In contrast, more long-stay nursing home residents experienced falls [during 2016 and 2020], but rates were better than expected in 2021,” the agency reported.

Within the safety measure, pressure ulcers among long-stay nursing home residents were 12.2% worse in 2020 and 15.7% worse in 2021.

CMS also noted that short-stay nursing home residents made improvements in function at an increased rate, from 63.1% to 66.9% between 2016 and 2020. Rates for this category were “better than expected” in 2021, according to the report.

Moreover, long-stay residents requiring help with activities of daily living decreased from 15.5% to 14.9% between 2016 and 2019, but were “worse than expected” between 2020 and 2021.

Meanwhile, performance on quality measures for long-stay nursing home residents such as use of physical restraints and urinary tract infections improved between 2016 and 2020. Long-stay residents experienced a declining use of physical restraints and fewer urinary tract infections during that time, while rates were better than expected for this category in 2021 as well.

On the other hand, emergency department visits per 1,000 beneficiary months worsened for short- and long-term nursing home residents between 2017 and 2019, the report found.

CMS concluded in its report that targeted initiatives implemented under the CMS Quality Improvement Organization umbrella supported progress in nursing homes, as well as hospitals and physician practices.

Quality priorities and corresponding measures with notable pre-pandemic impact included safety, specifically health care associated infections, wellness and prevention, and behavioral health, notably depression screening and follow up.

As for other measures, such as strains on the health care system, the report revealed a limited capacity by nursing homes to sustain improvements in quality.

“This report captures CMS quality measurement data from a unique moment in history: the onset of the Covid-19 PHE,” the agency said in its report. “Results for a large proportion of measures analyzed show deviations from prior performance trends, in some cases eroding recent gains. Uncertainty remains about the lasting effects of the pandemic and the resilience of the health care system.”

For its next report, CMS plans to use data to examine post-pandemic performance, and see what methods can be refined to figure out to what degree measure scores have returned to pre-pandemic trends. 

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