Nursing Home Industry Questions New CMS Rating System

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Some nursing home industry experts are questioning CMS' new rating system that ranks U.S. nursing homes on a five-star scale, the AP/Denver Post reports. Ratings, which are updated quarterly and posted online, mostly were based on state inspections, staffing levels and quality measures, such as how homes respond to a patient's declining mobility, high-risk bed sores and pain. According to the AP/Post, about 22% of the nearly 16,000 nursing homes in the U.S. received the lowest rating and 12% received the highest rating.

Some industry officials said that surveys conducted in some states are stricter than those conducted in others, and they cautioned against using the ratings to conclude that a certain state might have better nursing homes than another (Freking, AP/Denver Post, 12/18).

The National Citizen's Coalition for Nursing Home Reform said that the self-reporting survey information is "unreliable" and noted that homes that perform poorly actually can achieve as many as three stars if they are improving.

Bruce Yarwood, president of the American Health Care Association, said the rankings do not specifically measure quality but instead assess compliance with federal and state regulations. "We believe that customer satisfaction ... is a superior indicator," he said (Straus, CQ HealthBeat, 12/18). Martha Kutik, president and CEO of the Jennings Center for Older Adults in Ohio, agreed, saying that satisfaction should be high on the list if the system is measuring quality for consumers.

Kerry Weems, acting administrator for CMS, agreed satisfaction levels are important. "That's something we would like to do in the future," he said.

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Weems added that the system "should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision" (AP/Denver Post, 12/18).

Opinion/Editorial

USA Today on Friday published an editorial and opinion piece on the new ratings system.

* USA Today: The editorial praises the system, calling the effort a "remarkably consumer-friendly move" that makes comparison shopping for a nursing home "much easier" than before. Raw data on nursing homes have been available publicly for years, but "never in such an accessible format," the editorial adds. "Comparisons like these rankle reform-resistant health care providers but are a boon to consumers," according to the editorial. It concludes, "As crucial as zealous regulations of nursing homes is, some of the best quality control can be done by well-informed customers who search for the best homes and shun those that don't make the grade" (USA Today, 12/19).

* Yarwood, USA Today: The rankings system is "complex and inaccurate" and it "fails to provide the consumer with an appropriate tool to measure quality of care in our nation's nursing homes," Yarwood writes in a USA Today opinion piece. Yarwood writes there was a "lack of communication between CMS and providers to ensure that the final index included accurate, consistent and comparable data." According to Yarwood, the system is "an attempted oversimplification of the multifaceted long-term care profession" and "facilities that have been long recognized for outstanding quality care and patient outcomes have received inappropriately low ratings" (Yarwood, USA Today, 12/19).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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