New CMS Nursing Home Ratings Don't Solve Accuracy Issues: Senator

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By Michael D. Williamson

Aug. 10 — New nursing home ratings published on a Medicare-run consumer website don't answer questions about the system's accuracy, a Democratic senator told Bloomberg BNA Aug. 10.

The Centers for Medicare & Medicaid Services changed the overall five-star quality ratings on its Nursing Home Compare website by including data from another five quality measures, an Aug. 10 fact sheet said.

Increasing the number of measures on which nursing homes must report offers seniors and people with disabilities, along with their families, more information when picking a nursing home, Sen. Bob Casey (D-Pa.) said.

However, these changes don't “impact the accuracy and reliability of the measures reported,” Casey said, adding that he and Sen. Ron Wyden (D-Ore.) in 2015 asked the Government Accountability Office to examine the nursing home five-star rating system and help determine its accuracy (167 HCDR, 8/28/15).

Nursing Home Compare is a public website that consumers can use to search for and compare nursing homes. The site features a five-star rating system, which evaluates nursing homes' performance on health inspections, staffing levels and quality measures. These three ratings are combined to calculate an overall rating, which ranges from one star (the worst possible score) to five stars (the best possible score).

New Measures

The new quality measures reflect the rate of short-term nursing home residents who:

  •  are successfully discharged to the community;
  •  experience an outpatient emergency department visit;
  •  are rehospitalized; and
  •  make improvements in function.

A fifth quality measure looks at how many long-stay residents experience a decline in their ability to move independently.

“With the new quality measures added to the calculations, the quality measures star rating for each nursing home, as well as the overall rating, will likely change,” an Aug. 10 press release from the CMS said.

The CMS first announced in April that it would add the five quality measures (82 HCDR, 4/28/16). The Medicare agency originally planned to incorporate the new measures into the star ratings in July, it said at the time.

It also said then that it would include a sixth measure: the percentage of long-stay residents who received an antianxiety or hypnotic medication.

However, the CMS didn't incorporate that measure “because it has been difficult to determine appropriate nursing home benchmarks for the acceptable use of these medications,” the fact sheet said.

A nursing home industry group, the American Health Care Association (AHCA), didn't respond to requests for comment on the new quality measures. AARP, an advocacy group for senior citizens, told Bloomberg BNA Aug. 10 that it couldn't comment on the updating ratings at this time.

GAO Investigation

The GAO, the investigational arm of Congress, agreed to Casey and Wyden's request to investigate the nursing home five-star rating system in August 2015.

“We expect the GAO report to be published this fall [2016] and look forward to their recommendations on how the system can be improved,” Casey told Bloomberg BNA.

Casey and Wyden, in their letter to GAO requesting the investigation, said media reports questioned the rating system's integrity ever since the CMS made changes to the Nursing Home Compare website in 2015. In February 2015, the CMS added quality measures on antipsychotic medication use and staffing levels (35 HCDR, 2/23/15).

At the time, the CMS acknowledged that nearly one in three nursing homes would see a drop in their quality ranking with the rating system changes. Nursing home providers said those changes would result in confusion among customers.

The February 2015 changes “caused an estimated 4,777 of 15,500 centers nationwide to lose one or more stars in their individual quality rankings even though nothing about the quality of care those centers offered changed,” Greg Crist, senior vice president of public affairs at the AHCA,told Bloomberg BNA in August 2015.

To contact the reporter on this story: Michael D. Williamson in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

The CMS fact sheet is at

The Nursing Home Compare website is at

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