Tool Makes Nursing Home Inspection Reports Easy to Search

August 15, 2012 — A new interactive tool makes it possible to search the results of government inspections in 14,565 nursing homes nationwide. The tool allows users to determine, for example, whether a given nursing home has a pattern of elopement among residents.

The tool, called Nursing Home Inspect, draws on government reports that were posted online in July 2012 by the US Centers for Medicare and Medicaid Services. Users can search reports by keywords such as "elopement," which refers to patients leaving the property undetected, and results can be sorted by severity of violation. Although up to 31% of nursing home residents with dementia wander at least once, a pattern of elopement at a home can be a sign of inadequate supervision.

Nursing Home Inspect is an application created by Propublica, an independent, nonprofit newsroom whose mission is "to expose abuses of power and betrayals of the public trust by government, business, and other institutions, using the moral force of investigative journalism to spur reform through the sustained spotlighting of wrongdoing." The Nursing Home Inspect effort was led by Charles Ornstein and Lena Groeger.

Ornstein and Groeger used the Nursing Home Inspect Tool to search nursing home inspection reports and described the results online in an article titled, "What We Found Using Nursing Home Inspect."

According to the 2010 Census, approximately 1.5 million people live in nursing homes. Nursing homes are inspected regularly, and additional inspections occur when there is a complaint. The Government Accountability Office has found that 19% of the complaints investigated nationally in 2009 were substantiated and resulted in at least one citation. The proportion of citations varies greatly from state to state.

Over the decades, federal auditors have flagged numerous dangerous and neglectful conditions. Auditors have found, however, that inspectors tend to be lenient, citing too few problems and ranking them as less severe than they actually are.

Among advocates, there has been a longstanding call those who for nursing home residents to make federal nursing home inspection reports available to the public.

Nursing Home Inspect now makes the recently released reports searchable online. When the word "elope" is typed into the interactive tool, the application returns 949 inspection reports. Other terms also return hundreds or thousands of results. For example, "injuries" returns 7912 results, "MRSA" returns 514 results, and "ignore" returns 275 results.

The search tool also allows users to compare the severity of the deficiency (ranked A through L) among institutions.

Advocates for residents hope that the reports and the application will be used as a tool for fixing the specific problems of each nursing home.

The reports do leave out valuable information; most notably, the things that the facilities are doing well. In addition, associated plans for correction are not included online, although they should be available at individual nursing homes. The reports also may be biased, in that inspectors for different regions have a tendency to issue citations for different things. Elopement, for example, may be defined differently, depending on the state.

Sara Singer, MBA, PhD, is an assistant professor of healthcare management and policy at Harvard University, Cambridge, Massachusetts. She is not affiliated with the creators of the tool, but discussed its implications withMedscape Medical News via email: "[Physicians] need to use this tool with care; eg, by searching for multiple keywords if they're interested in a particular topic. Moreover, it's important to consider what the nursing home is doing to address citations (ie, by reviewing the Plan for Correction and by talking to people at the home), and for nursing homes where their patients reside, they should consider ways they can be part of the solution to any problems identified. Physicians have an important role to play in leading and inspiring improvement in nursing homes."

Dr. Singer has disclosed no relevant financial relationships.

Primary Care Physicians Boost Income in 2010, Survey Finds

June 15, 2011 — Primary care physicians saw modest increases in their 2010 compensation, while some of their better-paid specialist colleagues lost ground, according to a new survey of almost 60,000 physicians around the United States from the Medical Group Management Association (MGMA).

In the Physician Compensation and Production Survey: 2011 Report Based on 2010 Data, internists were found to have earned a median of $205,379, which is an increase of 4.21% since 2009. Family physicians (without obstetrics) saw their median incomes rise by 2.94% to $189,402, and pediatricians had a compensation increase of 0.39% to $192,148, which did not keep up with the low inflation rate.

Six specialties — anesthesiologists, gastroenterologists, obstetricians/gynecologists, ophthalmologists, diagnostic radiologists, and urologists — have had modest declines in income since 2009. The largest decrease was a drop of 4.66% for urologists, who earned a median of $372,455, the survey found.

Psychiatrists, dermatologists, neurologists, general surgeons, and emergency medicine physicians were among the specialists who reported an increase in median compensation since 2009. The largest percentage increase of 5.65% was for emergency medicine physicians, who earned a median of $277,297.

Orthopaedic surgeons were the top earners in the survey, at a median compensation of $514,659 (up 3.71%), followed by invasive cardiologists ($500,993), diagnostic radiologists ($471,254), gastroenterologists ($463,995), and dermatologists ($430,874).

Physicians practicing in the South reported the highest median earnings, at $216,170 in primary care and $404,000 in specialty care. They were followed by physicians in the Midwest and West. Physicians in the East earned the least, at $194,409 in primary care and $305,575 in specialty care.

"A number of factors may attribute to regional differences in physician compensation," Jeffrey B. Milburn, MBA, CMPE, from the MGMA Health Care Consulting Group, said in a news release. "The supply and demand for primary care or specialty physicians may influence compensation. A high level of competition between groups or specific specialties may provide an opportunity for payers to reduce reimbursement. In states where payers have little competition, reimbursement and subsequent physician compensation may be lower.

"Location desirability is another factor influencing competition and compensation," Milburn noted. "Some areas have a much higher ratio of physicians to population, and one might think this would lead to increased competition and lower compensation. But the usual laws of supply and demand aren't always at work in health care."

MGMA, based in Englewood, Colorado, is an association for professional administrators and leaders of medical group practices. It serves 22,500 members who lead 13,600 organizations nationwide in which some 280,000 physicians provide more than 40% of the healthcare services delivered in the United States, the group says. MGMA notes that its surveys depend on voluntary participation and may not be representative of the industry.