Doctor helping old patient with Alzheimer's disease.

By: I. Paul Mandelkern:

To help residents and their families find a quality Medicare or Medicaid certified nursing home and to encourage nursing homes to achieve high quality by public reporting of quality measures, in 1988 the Centers for Medicare & Medicaid Services (CMS) started its Nursing Home Compare website.  In 2008 CMS modified the website to provide a five-star rating system with one star being the lowest possible score and five being the highest.  The rating system is based on three types of measures: state health inspections, staffing ratios, and quality measures.

Over the years CMS’ five-star rating system has been subject to much criticism by advocates for residents because the system relies heavily on self-reported data resulting in a high percentage of nursing homes that scored four or five stars. In 2014 the New York Times reported, in a much publicized article, that nursing homes have learned how to “game” the five-star rating system and that “even nursing homes with a history of poor care rate highly in areas that rely on self-reported data.”

Last month CMS announced that six new quality measures are being added to the Nursing Home Compare website.  Significantly, three of the six new quality measures are based on Medicare claims data submitted by hospitals, which is the first time CMS has included quality measures that are not based solely on data that is self-reported by the nursing homes. These three quality measures measure the rate of rehospitalization, emergency room use, and community discharge among short-stay nursing home residents. The other three quality measures, which rely on self-reported data, measure the rate of short-stay residents who improved in function, the rate of long-stay residents whose ability to move independently worsened, and the rate of long-stay residents who received antianxiety or hypnotic medication.

These new quality measures, with the exception of the antianxiety/hypnotic medication measure, will be incorporated into the calculation of the nursing home star ratings on Nursing Home Compare starting this July.  It will be interesting to see if their new measures result in lower overall star ratings for the nursing homes.

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