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

Dr. 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.”