California Healthline Daily Edition

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CMS Revising Nursing Home Compare Rating System

The federal government has revised how it will evaluate nursing homes in a way that makes it harder for facilities to receive top scores, the New York Times reports (Thomas, New York Times, 2/12).

Background

Medicare's Nursing Home Compare rating system is used to rate nursing home facilities. The best possible rating Medicare can give to a nursing home is five stars.

Last August, a Times investigation found that the star-rating system often is based on incomplete information and can therefore mislead consumers and other stakeholders about nursing homes' conditions (California Healthline, 8/25/14). According to the investigation, ratings largely are based on self-reported data from the facilities that are not verified by the federal government, including staff levels and quality measures.

Details of the Changes

The updated ratings build off of earlier revisions, according to the Times. Last October, the government said it planned to require nursing home facilities to report staffing levels quarterly as part of a federal audit (New York Times, 2/12).

Under the adjusted ratings, the government expects facilities to earn a minimum of three stars of ratings related to staffing levels for registered nurses, licensed practical nurses and certified nursing assistants, Modern Healthcare reports. Sufficient staffing in these areas is related to fewer medication errors and lower incidence of patient complications, according to Modern Healthcare (Rice, Modern Healthcare, 2/13).

In addition, the ratings will now include quality measures about appropriate use of antipsychotic medications. According to the Times, such medications are given to elderly dementia patients often New York Times, 2/12).

Further, CMS said it will increase its use of on-site visits by state survey agencies as a way to assess the information the facilities report. Results from a pilot program involving five states will be available Feb. 23 (Modern Healthcare, 2/13).

Federal officials expected scores would drop for many facilities. Facilities were able to view their new scores last week and the public will be able to review them on Friday.

Reaction

Mark Parkinson -- president and CEO of the American Health Care Association, which represents for-profit nursing homes -- said facilities "are concerned the public won't know what to make of these new rankings." He added, "If centers across the country start losing their star ratings overnight, it sends a signal to families and residents that quality is on the decline when in fact it has improved in a meaningful way."

CMS official Thomas Hamilton said the ratings website will explain the changes (New York Times, 2/12).

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