CDC Has Improved the Nursing Homes Reporting Process for COVID-19 Data in NHSN, but Challenges Remain

KEY TAKEAWAY

The Centers for Disease Control and Prevention (CDC) struggled to support nursing homes during mass enrollment into the National Healthcare Safety Network (NHSN) in 2020 and as COVID-19 reporting requirements changed throughout the pandemic. CDC has improved the nursing home reporting process and guidance, but some challenges remain. Continued improvements to NHSN user support and data quality will be important for continued reporting on vaccinations and for future public health surveillance.

WHY WE DID THIS STUDY

NHSN has served as a critical source for monitoring the effects of the COVID-19 pandemic, and informing the Federal, State, and local pandemic response. In May 2020, the Centers for Medicare & Medicaid Services (CMS) issued a requirement for nursing homes to report COVID-19 data to NHSN. CDC has operated NHSN since 2005, but nursing home reporting had been voluntary, with participation from only a small proportion of facilities. The reporting requirement resulted in the influx of thousands of nursing homes enrolling in and reporting to NHSN in 2020, while they, and CDC, also responded to the pandemic.

This evaluation provides insights into nursing home experiences enrolling in and reporting to NHSN, and CDC efforts to facilitate reporting such as user support for facilities facing difficulties. These insights can help CDC address ongoing challenges, and mitigate potential issues in future updates or expansions.

HOW WE DID THIS STUDY

We administered an electronic survey to a simple random sample of 197 nursing homes from a population of 15,324 facilities that have reported COVID-19 data to NHSN, and interviewed a subset of facilities. We also interviewed CDC and CMS officials to understand CDC efforts to facilitate nursing home enrollment and reporting to NHSN. We based our findings on analysis of survey and interview responses.

WHAT WE FOUND

Despite CDC efforts, both CDC and nursing homes experienced difficulties during a mass enrollment of more than 12,000 facilities into NHSN to begin reporting COVID-19 data in May 2020.

As the pandemic continued, CDC added data variables to NHSN, including fields with personally identifiable information, in response to emerging data needs and new Federal reporting requirements. Nursing homes had to upgrade their security access levels to report the sensitive data. At this time, CDC experienced a significant backlog of support requests, which also inhibited some facilities from accessing NHSN.

CDC improved the process of nursing home reporting to NHSN throughout the pandemic. Facilities acknowledged this effort and reported that CDC support improved, but some continued to experience difficulty getting assistance. Additionally, a quarter of nursing homes reported lacking confidence in the quality of NHSN data, despite the quality assurance checks CDC conducts on key variables.

After December 2024, CMS reporting requirements for some key variables will expire, but the mandate for reporting vaccination-related data will remain. CDC stated that it will continue to support voluntary reporting of COVID-19 data and other infection and quality measures, and modernize NHSN reporting processes. Stakeholders and CDC expressed that having nursing home participation in NHSN is valuable for public health surveillance, and the agency is exploring opportunities to leverage the current national enrollment for reporting on other health outcomes.

WHAT WE RECOMMEND

To continue improvements, we recommend that CDC (1) improve the user support the NHSN Help Desk provides to nursing homes, (2) take further steps to ensure the quality of nursing home reporting of COVID-19 data to NHSN, and (3) consider how quality assurance checks can be enhanced to ensure data accuracy, as appropriate. CDC partially concurred with our first recommendation and concurred with our second and third recommendations.