RESEARCHFactors Associated with Nursing Homesʼ Late Participation in COVID ‐19 Reporting

Abstract

On April 19, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the requirement that nursing homes should inform residents and their families of COVID-19 outbreaks. In addition, nursing homes were required to report COVID-19–related cases and deaths directly to the Centers for Disease Control and Prevention.1 The initial deadline for the submission of COVID-19 data was May 17, 2020, and CMS extended the grace period to May 31, 2020. The COVID-19 Nursing Home Data were published by May 31, 2020. Still, about 12% of nursing homes did not follow the requirement to report the COVID-19 data.2 Starting on June 7, 2020, nursing homes that did not submit COVID-19 data would receive a warning notice of $1,000 with $500 for each additional week.3 We analyzed data from the CMS Nursing Home COVID-19 Public File, together with the latest data from the Nursing Home Compare File, Long-Term Care Focus, and the county-level data from the Area Health Resources File. Multivariate logistic regression was used to estimate the association between late reporters and nursing home characteristics and county-level demographic parameters. Among the 15,418 nursing homes, 1,770 (11.5%) did not participate in COVID-19 reporting by May 31, 2020. There was some variation in participation rates across states (Figure 1). Four states (Idaho, South Dakota, New Hampshire, and Massachusetts) had high participation rates (>95%) in COVID-19 data reporting. The West states, including California, Nevada, New Mexico, Utah, and Montana, the Midwest states (Kansas), states from the South, like Oklahoma and Texas, together with Alaska, had a lower participation rate, which was below 85%. Smaller nursing homes, as measured by average residents' daily census, were less likely to report COVID-19 data (odds ratio (OR) =0.96; P < .001). Nonchain nursing homes were less likely to report data (OR = 0.74; P = .001). When comparing nursing homes with four-star quality ratings, nursing homes with three-star ratings were less likely to follow instructions and report COVID-19 data to CMS (OR = 0.75; P = .044). Measured by years of operation, newer nursing homes were less likely to report COVID-19 cases (OR = 0.99; P = .014). Nursing homes with a higher percentage of White residents and residents aged 65 years and older were less likely to be late reporters (OR = 0.996 (P = .05); and OR = 0.991 (P = .001), respectively). Participation in data reporting requires particular information technology infrastructure and additional human and financial resources,4 which may create barriers for smaller nursing homes. A recent study found that smaller nursing homes had a lower probability of having any COVID-19 cases, but after adjusting the size, they had a much higher outbreak size compared with nursing homes with more than 50 beds.5 It is possible that smaller nursing homes had more COVID-19 cases adjusted by bed capacity. Therefore, they did not have additional resources to report to CMS. A similar trend was observed between chain-affiliated and freestanding nursing homes. Nonchain nursing homes may lack resources to conduct reporting, and they were more likely to have COVID-19 cases.5 The finding of this study may signal a need to help small and nonchain nursing homes in receiving incentives or resources from CMS to overcome barriers in COVID-19 reporting. Nursing homes that operated longer in the market were more familiar with the requirement by the government in quality reporting, and they were more prepared with resources to comply with COVID-19 reporting. A study found that older adults (aged >65 years) faced a higher risk in getting COVID-19 and developing into critical conditions.6 With more severe cases and higher death rates from older residents, especially those who are older than 65 years, nursing homes may pay more attention to COVID-19 reporting. We also spotted the racial disparity in reporting COVID-19 cases. Nursing homes with a higher percentage of minority populations were less likely to participate in reporting. Previous studies found that minority residents in nursing homes were more subject to coronavirus, which indicated a disproportionate impact of COVID-19 among different racial and ethnic groups.5, 7-9 Our study is consistent with previous findings, and CMS may need to focus on nursing homes with more minority residents and explore the underlying reasons for the disparity in COVID-19 reporting and residents' cases and deaths. In conclusion, CMS successfully collected COVID-19 data from nursing homes with a wide geographical variation in participation. Additional support may be needed to help small and nonchain nursing homes to make sure they have sufficient resources to comply. We want to thank Centers for Disease Control and Prevention's National Healthcare Safety Network and Centers for Medicare & Medicaid Services, who collected and shared the COVID-19 nursing home data. There is no conflict of interest in this article. Y.L. and