As promised in a Feb. 12 call to providers, the Centers for Medicare & Medicaid Services (CMS) publicly announced changes to the five-star rating system used on its Nursing Home Compare website today.
Beginning today, the ratings will:
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- Include the use of antipsychotic medications. The two existing quality measures, one for short-stay and one for long-stay patients/residents, now will be part of the calculation for the quality measures star rating.
- Arrive at staffing level ratings differently.
- Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.
“CMS is committed to improving Nursing Home Compare and the five-star quality rating system to ensure they are the most trusted and easy-to-use resources we can provide,” Patrick Conway, MD, CMS deputy administrator for innovation and quality and chief medical officer, said in a statement. “Consumers can feel confident that Nursing Home Compare’s star ratings include measures that matter most to nursing home residents and their families and challenge nursing homes to continuously improve care.”
Quality measure decline
CMS rates nursing homes on three categories: results from on-site inspections by surveyors, performance on certain quality measures and staffing levels. All three categories combine for an overall rating, and consumers also can see ratings for the three categories individually.
CMS said that, because the standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating, even if their actual performance does not differ from previous reporting. Specifically, CMS expects that about two-thirds of nursing homes will see a drop in their quality measures rating, and about one-third will see a drop in their overall five-star rating.
For example, before the recalibration, about 80 percent of nursing homes received either a four or five-star rating on their quality measures. Now, about 49 percent of nursing homes will receive four or five stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the recalibration.
CMS says it is making the changes to serve consumers, but at least one organization questions whether that goal will be met.
“Any time that nearly a third of an entire sector is impacted by a change of this magnitude, there will be confusion,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, said in a statement. “We’re not helping patients and their families get the information they can trust when the star rankings don’t match the quality care being delivered.”
LeadingAge expressed concerns as well.
“The announcement today does not change our view that the five-star rating system is a great idea, but [it] was hastily and prematurely implemented,” Larry Minnix, president and CEO of LeadingAge, said in a statement. “CMS continues to tweak it without addressing or correcting underlying fundamental flaws.”
Quality should be at the forefront of all discussions of nursing homes, Minnix said, but “arbitrary” changes to the cut point thresholds for quality measures negate accomplishments in improved quality for nursing homes and other stakeholders—families of residents and potential residents, employees of nursing homes, and the integreted health systems with which nursing homes have relationships—as well, the group maintains.
“We hope CMS will more aggressively pursue fixing the fundamental flaws behind five-star, because the public deserves a tool that is easy to understand and is supported by reliable criteria,” Minnix said, noting that LeadingAge supports the inclusion of antipsychotic medication use in five-star rating calculations as well as a revision of the way staffing levels are determined. “But we aren’t there yet.”
The Nursing Home Compare website launched in 1998, and CMS added the five-star ratings in 2008.