ARE NURSING HOME RATINGS ACCURATE?

Nursing homes that accept medicare dollars (which, as you can imagine, are most of them) are regulated by the Centers for Medicare Services, which is called CMS for short. As part of its job of regulating these nursing homes, CMS conducts annual surveys on the health care, safety, and quality of life of the residents in the nursing homes. The surveys are then boiled down into a five-star rating system, giving each nursing home a star rating of one star (worst) to five stars (best). The rating system can be accessed here.

But in February Medicare changed their ratings system, and as a result many nursing homes were taken down a peg in the five-star system. As you can imagine, this caused some considerable backlash since nursing homes are paid on a per-resident basis. Basically the nursing homes are competing for residents, because the more residents they have the more money they get from Medicare. Two U.S. Senators have even called for an investigation into why ratings have changed.

So what changed? Here’s Medicare’s official explanation:

We have made 3 significant improvements to the Five Star Nursing Home Quality Rating System:

  1. Incorporated the 2 nursing home quality measures for antipsychotic use into the Quality Measure Rating.
  2. Increased the number of points necessary to earn a Quality Measure Star Rating of 2 or more stars.
  3. Changed the scoring method for the Staffing star rating. Nursing homes must earn a 4-star rating on either the RN or total Staffing rating to achieve an overall Staffing rating of 4-stars.

Many nursing homes will see a lower quality measure rating as a result of these changes, even though the underlying QM data may not have changed. Because of these changes, it is not appropriate to compare a facility’s QM ratings that appear in February with those that appeared in earlier months.

Basically Medicare did the equivalent of changing the grading system mid-semester. But keep in mind that nursing homes are reviewed only annually, so those that had been reviewed prior to the change have to wait until their next review to see if they can get their star rating back on track.

Personally I’m not sure that the dip in ratings is going to make a huge difference. To many consumers looking at nursing homes, there’s not a lot of distinction between “above average” and “much above average” in the ratings system.

I’ve written before about nursing home ratings and how some nursing homes can game the system. By far the most important thing to do is to visit  prospective nursing homes before making a choice. Medicare’s ratings are based on one inspection, not on a months or years-long stay, so they shouldn’t be the only thing to consider.

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