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No Surprise – GAO Finds Infection Control Deficiencies Widespread Prior to COVID-19

In a report issued May 20, 2020, The Government Accountability Office (GAO) found that infection control deficiencies in nursing homes were “widespread and persistent” prior to COVID-19. However, since the report is from the GAO, it emphasizes what The Centers for Medicare & Medicaid Services (CMS) and State Agencies did – and didn’t – do on survey. The data set used for the development of these findings is from 2013-2017, excluding the timeframe after the updated Requirements of Participation (RoPs) went into effect at the end of November in 2017. This means that the GAO was reviewing deficiencies cited under the old F441 tag, not the current regulatory tags, which now have been broken out into multiple Ftags (F880-F885, including the new COVID-19 reporting Ftags) that each look at specific infection control requirements.

What the GAO Found

  • Each year from 2013-2017, approximately 39-41% of nursing homes received an infection control deficiency on survey. After the RoPs were updated and the Long-Term Care Survey Process was implemented, GAO found that approximately 40% of nursing homes still received an infection control citation on survey. We have been showing F880 Infection Prevention and Control as one of the most frequently cited deficiencies across the country since the LTCSP became effective, so this is not surprising.
  • 48% of facilities received more than one infection control deficiency during the period of 2013-2017. The GAO stated that this is “indicative of persistent problems,” however, based on the CMS-2567s that we review routinely, facilities can be cited for one issue under infection control on one survey, such as hand washing, and a different issue, such as catheter tubing touching the floor, on another survey. Both are still infection control issues, but not necessarily indicative of repeat or a persistent program issue, although it is widely acknowledged that infection control is an area that needs more focus by providers to improve consistency in practices.
  • At the state level, all states had nursing homes that received infection control citations.

Here is where the finger starts getting pointed at the surveyors:

  • Approximately 99% of infection control deficiencies cited each year from 2013-2017 were cited at a scope and severity of less than actual harm (lower than S/S: G), which as GAO classified these findings, are “not severe.”
  • CMS also rarely implemented enforcement actions for these deficiencies over the same time period. Only 1% of the “not severe” infection control deficiencies had an enforcement action implemented.
  • 67% of the infection control deficiencies cited did not have any enforcement actions imposed or implemented.
  • 31% had enforcement actions imposed by not implemented, which GAO notes, is probably due to the facilities having the opportunity to correct the citations before an enforcement was imposed.

GAO stated that it plans to look at the CMS response to the COVID-19 pandemic in future work, and that it will review CMS guidance and oversight of infection prevention and control in another report. What does that mean for providers? As CMS Compliance Group, Inc. President, Linda Elizaitis, mentioned in her April 17, 2020 CMSCG Blog post, expect increasing scrutiny of your facility’s infection prevention and control practices. In a post-COVID world (whenever that is), the focus on infection control is not going away.

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