Variation in the use of nursing home deficiency citations

Several sources of variation are associated with the number of survey deficiencies that can be received by nursing homes in the yearly survey and certification process. One source is variation across states. A second source of variation occurs within states. A third source of variation occurs for each facility across time. As measures of quality, large degrees of inconsistency are likely inappropriate and inefficient; thus, in this study survey deficiency variability was examined. The data used came from the 1991 through 2003 Online Survey, Certification, and Reporting system. We used two measures of deficiencies: (1) the number of quality-of-care deficiency citations (19 citations) and (2) all 185 deficiency citations. The results of the analyses suggest that recent changes by the Centers for Medicare & Medicaid Services (CMS) in the survey and certification process have had little impact on the considerable variation in the use of deficiency citations. The high degree of variation limits the usefulness of deficiency citations not only for CMS but also for consumers and providers.