CMS Announces Changes to the Nursing Home Compare 5-Star Quality Rating System

From LeadingAge | February 13, 2015

Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced a new approach in the way it will calculate the scores for the Nursing Home Compare, 5-Star Quality nursing home rating system.

“LeadingAge has long maintained there should be two types of nursing homes: the excellent and the non-existent. Quality should be an automatic public expectation,” said President and CEO Larry Minnix.

LeadingAge supports a consumer-friendly nursing home rating system based on reliable quality information that the public can understand. The five-star rating system is a great idea, but was hastily and prematurely implemented. CMS continues to tweak it without addressing or correcting underlying fundamental flaws.

This approach will likely impact many LeadingAge members, who might see a one-to-two star drop in their total number of stars based on the new calculation, in spite of the fact that their quality has not deteriorated. LeadingAge supports the addition of a calculation that measures antipsychotic use and one that revises the current way that staffing levels are determined. Typical of the 5-Star rating, there is no transparency about the calculations, making it difficult for providers to know how to improve their facilities. This can confuse residents, families, and the public.

Government and providers must be responsible, transparent, and accountable for how quality is defined and measured for programs that serve vulnerable people and that are funded by taxpayer dollars through Medicare and Medicaid. CMS has a key responsibility for defining, measuring, and overseeing quality. Providers have the key responsibility in delivering quality.

Five-Star should be a factor, but not a determinant when choosing an excellent nursing home. How does the consumer determine whether a nursing home is excellent? The Nursing Home Compare tool is one indicator that can serve as an indicator of quality. More important is reputation; observation of staff-resident interactions; availability of senior management to address resident and family concerns; a five-senses test; and an in-person visit.

LeadingAge believes it is possible to improve this system to meet CMS’ goals of offering consumers easy-to use information to help when choosing a facility, discussing quality of care, and assisting providers with quality improvement. However, the current process must continue to be revisited and reevaluated, and the necessary improvements and modifications effected openly and transparently.

“We hope CMS will more aggressively pursue fixing the fundamental flaws behind 5-Star because the public deserves a tool that is easy to understand and is supported by reliable criteria. But we aren’t there yet,” says Minnix.

CMS will provide more information about the details of the new calculations on February 20, 2015.