CMS Changes Nursing Home Rating System

The Centers for Medicare and Medicaid Services (CMS) announced that it will reveal its new Nursing Home Compare 5-Star Quality Rating System to the public on February 20, 2015.   CMS will change its ratings to raise the bar for achieving a high rating in the Quality Measures category.  Thus, ratings will likely fall for many nursing homes even though there has been no change in the quality of care.

CMS is raising the standards for nursing homes to achieve a high rating in the Quality Measures category by increasing the numbers needed to achieve a particular star category.  According to CMS, in 2008 the initial scoring for the Quality Measures rating was set at a distribution that reflected the status quo with the expectation that there would be progress and changes to the quality measures thresholds over time.  When nursing homes have made progress in raising performance standards, CMS resets the distribution to promote further progress.

In addition to raising performance expectations, CMS is making the following changes to the 5-star rating system:

  • Additional Quality Measures:  CMS added two additional quality measures for antipsychotic medication use in nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
  • Staffing Algorithms:  CMS adjusted these measures to more accurately reflect staffing levels.
  • Survey Expansion:  CMS announced a plan for State Survey Agencies to conduct specialized, onsite surveys of a sample of nursing homes in the country to assess the adequacy of resident assessments and the accuracy of information reported to CMS that is used to calculate quality measures.

These changes to the 5-Star Quality Rating System are the third major revision to the Nursing Home Compare website since it was launched in 1998.  CMS says that a fourth change is scheduled for 2016.

CMS Plans to Expand Five-Star Rating System Beyond Nursing Homes

HC BLOG_five starsDr. Patrick Conway, a deputy administrator at the Centers for Medicare and Medicaid Services (CMS) announced on CMS’s blog in June that the agency plans to add a star rating system later in 2014 and early in 2015 for several other health care providers.  According to Conway, CMS plans to add a star rating system to the Hospital Compare, Dialysis Facility Compare, and Home Health Compare websites.  The Nursing Home Compare website already uses star ratings, and the Physician Compare website just started to include star ratings for certain physician group practices.

CMS launched the five-star system for nursing homes in December 2008.  The overall five-star rating for each nursing home is based upon the star ratings for three separate categories: 1) health inspections; 2) quality measures; and 3) staffing.  To determine a nursing home’s overall rating, CMS begins with the facility’s health inspection rating and then adds or subtracts “stars” depending on the facility’s staffing rating and its quality measures rating.  Thus, a facility’s overall rating is an aggregate of its scores in these three areas.

Although CMS intended that consumers use the five-star rating system to help them choose nursing homes, the system has been used beyond its intended purpose.  For example, in tort cases against a facility, attorneys for nursing home residents and/or family members frequently attempt to introduce into evidence the nursing home’s five-star rating.  It is possible that the same situation will occur with the five-star rating system CMS intends to launch for hospitals, dialysis facilities, and home health companies.  However, CMS never intended that the five-star nursing home rating system should serve as a standard of care.  In fact, CMS states that the quality measures (one of the components of the five-star rating) on Nursing Home Compare “[a]ren’t benchmarks, thresholds, guidelines, or standards of care, and aren’t appropriate for use in a lawsuit.”