Ways and Means, Energy & Commerce Leaders Release GAO Report on Skilled Nursing Facilities

Press Release

Ways and Means Committee Ranking Member Sander Levin (D-MI), Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), Ways and Means Subcommittee on Health Ranking Member Jim McDermott (D-WA) and Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade Ranking Member Jan Schakowsky (D-IL) today released a new report from the non-partisan Government Accountability Office (GAO) concluding the Centers for Medicare & Medicaid Services (CMS) needs to improve accessibility and reliability of expenditure data for skilled nursing facilities.

Skilled Nursing Facilities (SNFs) provide short-term skilled nursing and rehabilitative care following a hospital stay for a surgery, a severe injury or illness. In 2014, Medicare paid $28.6 billion for nearly 1.7 million beneficiaries who received SNF services at approximately 15,000 facilities nationwide.

The GAO report was requested by the four lawmakers after concerns were raised about the difficulty of accessing spending data for direct or indirect care for patients. This data is required to be available under the Affordable Care Act (ACA) to assist consumers and advocates in analyzing and finding the best quality of care.

Better availability of data and improved oversight is critical to improve patient care. In particular, nurses and patient advocates have consistently called for more attention to staffing ratios. This data provides an interesting starting point for stakeholders to come together and improve patient care.

"This GAO report provides critical recommendations about the importance of spending data to help improve the quality of care at skilled nursing facilities across the country," saidSchakowsky, Levin, Pallone and McDermott. "We need timely, usable and accurate information about spending so that consumers can make sound choices about their health care and policymakers can ensure that Medicare payments are being spent on patient care and nurse staffing."

The GAO analyzed data from Fiscal Year (FY) 2011 through FY 2014 and found that:

Expenditure data was difficult for the public and researchers to access;

Self-reported data could not be guaranteed to be accurate;

Average direct and indirect care spending was lower for for-profit SNFs compared to nonprofit and government facilities, while average for-profit margins were higher;

Average direct and indirect care spending was lower for chain SNFs compared with independent SNFs, while average chain SNF profit margins were higher;

While nurse staffing ratios were lower at for-profit SNFs, other factors (such as geographic location and state staffing laws) were more important predictors of staffing ratios.

Based on these findings, GAO recommended that the Acting Administrator at CMS take the following two actions to improve the accessibility and reliability of SNF expenditure data: 1) take steps to improve the accessibility of SNF expenditure data, making it easier for public stakeholders to locate and use the data; 2) take steps to ensure the accuracy and completeness of SNF expenditure data.