Quality Rating Stars are Posted on Nursing Home
Compare Website by CMS
Some nursing homes may not like their ratings but
site gets support of aging committee chair
CMS Quality Ratings
by Stars
Nursing homes are rated overall and on health inspections,
nursing home staffing and quality measures. More stars are
better.
Dec. 22, 2008 - For the first time in history, the Centers for
Medicare & Medicaid Services (CMS) has released quality ratings for each
of the nation’s 15,800 nursing homes that participate in Medicare or
Medicaid. Although some nursing homes were unhappy with their ratings,
Sen. Herb Kohl, chair of the Senate’s committee on aging, gave it a
thumbs up and said he believes it will motivate the nursing homes to
provide the best possible care.
Part B, one of four Medicare parts, covers some
medical expenses not covered by Part A - doctors’ fees,
outpatient hospital visits, and other medical services and supplies
Adds two quality measures showing how well
dialysis patients are treated for anemia, information to help seniors
better understand facility survival rates
Facilities are assigned star ratings from a low of
one star to a high of five stars based on health inspection surveys,
staffing information, and quality of care measures. The ratings are
publicly available on the agency’s Nursing Home Compare Website. A link
to the page is found at
www.medicare.gov or readers can go direct by
clicking here.
“Our goal in developing this unprecedented quality
rating system is to provide families a straightforward assessment of
nursing home quality, with meaningful distinctions between high and low
performing homes,” said CMS Acting Administrator Kerry Weems. “The new
information will also help consumers and families identify important
questions to ask nursing homes and challenge nursing homes to improve
their quality of care.”
The new rating system also received high marks from
Sen. Kohl (D-WI), chairman of the Senate Special Committee on Aging.
“With this new rating system, CMS is improving the ability of consumers
to readily obtain critical information which should be used in
conjunction with in-person visits to a facility.
“Transparency is key when it comes to nursing home
quality,” said Sen. Kohl. “I commend Acting Administrator Weems today
and, as always, appreciate the opportunity to work together to improve
our nation’s nursing homes.” (See complete Kohl statement below news
report.)
Consulting with a panel of experts from academia,
patient advocacy and nursing home provider groups, CMS developed the
rating system based on each nursing home’s performance in three critical
areas:
Health inspection surveys. Each year state and federal surveyors conduct about 15,800 on-site,
comprehensive assessments of each nursing home’s health care services
and compliance with federal/state rules. These surveys are designed to
help protect the health and safety of residents, including resident’s
rights and general quality of life. Surveyors also conduct about 50,000
complaint investigations each year. Information from the most recent
three years of survey findings were used to develop the ratings.
Quality measures. The quality rating system uses 10 key quality measures out of the 19
that can be found on the Nursing Home Compare Web site. Areas examined
include the percent of at-risk residents who have pressure ulcers (bed
sores) after their first 90 days in the nursing home, the number of
residents whose mobility worsened after admission, and whether residents
received the proper medical care.
Staffing information. There is strong evidence that low staffing levels can comprise the
level of patient care in a nursing home and is considered an important
indicator of quality. This measure reports the number of hours of
nursing and other staff care per patient per day. This measure is
adjusted to account for the level of illness and services required by
each facility’s residents.
The Web site provides the public with a quality
rating for each of the three areas listed, as well as a composite or
total score.
● A five star designation means the facility ranks
“much above average,”
● four star indicates “above average,”
● three means “about average,”
● two is a “below average”
● ranking with a one indicating that a facility ranks “much below
average.”
Rankings are dynamic and will be updated monthly.
“Because quality and conditions within a nursing
home can change at any time, this system is not intended to be the only
tool families use in selecting the right nursing facility for a loved
one,” Weems noted. “Nursing homes can make dramatic improvements
between rating periods, just as a previously highly-rated home could see
its quality of care deteriorate. And nothing can substitute for
visiting a nursing home.”
In this first round of quality ratings about 12
percent of the nation’s nursing homes received a full five star rating
while 22 percent scored at the low end with one star. The remaining 66
percent of facilities were distributed fairly evenly among the two,
three and four star rankings.
“Choosing a nursing home or community-based care is
one of the most difficult and sometimes confusing decisions families
have to make,” noted Thomas Hamilton, director of the CMS Survey and
Certification Group who helped develop the new system. “The new Web
site improvements also include links to information for community-based
alternatives to nursing homes that may be of great interest to families.
“Regardless of the type of support a family
chooses,” he said, “It is vital that families and caregivers use the Web
site as just one of many important sources of information they should
consult. Families should also consult with their physician, talk to the
state’s nursing home ombudsman or the state’s survey and certification
office and, most importantly, visit the nursing home or community-based
program for themselves.”
The addition of the five-star quality rating system
is just the latest in a series of improvements to the Nursing Home
Compare Web site.
In November 2007, CMS took another historic step in
publishing a list of the nation’s nursing homes with consistently poor
performance records. Nursing homes selected as such “Special Focus
Facilities (SFF)” are provided with increased oversight, including
onsite inspections that occur twice as often as better performing
homes. Homes with the SFF designation are clearly marked on the Compare
Web site.
“Around three million Americans depend on nursing
homes at some point during each year to provide life-saving care,” Weems
said.
“Most of those individuals are enrolled in Medicaid
or Medicare and we all bear a special responsibility to protect their
health and welfare. Adding this new quality rating system to our Web
site is a huge step toward giving our beneficiaries and their loved ones
meaningful information to compare nursing homes more easily.”
CMS has also published an updated version of its
Guide to Choosing a Nursing Home which can help families through the
process. The Guide can be also be accessed at
www.medicare.gov.
The five star ratings on Nursing Home Compare are
the most recent information to be added to the consumer information
available at
www.medicare.gov. Users can find up-to-date information about
hospitals at Hospital Compare (www.hospitalcompare.hhs.gov)
and dialysis clinics at Dialysis Facility Compare (www.medicare.gov/Dialysis),
as well as information about Medicare health and prescription drug plans
(www.medicare.gov/mppf
and
www.medicare.gov/mpdpf).
Statement from Special Committee on Aging
Chairman Herb Kohl (D-WI)
“When it comes to nursing home quality and
transparency, I firmly believe two things. First, that Americans should
have access to as much information about a nursing home as possible.
This information should include the results of independent safety
inspections; the health status of residents, which is closely tied to
the quality of services provided; the number of direct care staff
responsible for providing hands-on care; and basic information about a
home’s management and ownership.
“Second, I believe that the federal government has
a responsibility to ensure that consumers can readily obtain this
information in a clear manner, so that it can be used to help in making
the best possible decision about which home is right for their loved
one.
“CMS meets the first obligation fairly well,
posting much of this data on the government’s website Nursing Home
Compare. And with the implementation today of their five-star rating
system for nursing homes, they are getting closer to meeting the second.
“Transparency is the key to nursing home quality.
When Nursing Home Compare succeeds in delivering comprehensible and
reliable information on nursing homes nationwide, I believe that the
power of public opinion will motivate facility owners, managers, and
staff to provide the best possible care and meet the kind of standards
they would be proud to see posted online.
“As the 111th Congress gets underway, Senators
Chuck Grassley (R-IA) and Ron Wyden (D-OR) will join me in working to
bolster this type of transparency through the Nursing Home Transparency
and Improvement Act, which AARP has called “one of the most significant
nursing home reform initiatives” in two decades. Americans seeking care
in any health care or long-term care facility deserve to know that the
care they expect is going to be provided.
“We can make that happen by ensuring that the
information on Nursing Home Compare is based on credible, auditable
data. As this five-star rating system is implemented and improved upon,
I trust that CMS will strive to make these nursing home rankings as
accurate and timely as possible. I have recommended that CMS make it a
priority to compare the inspection records of long-term care facilities
within states. I have also urged the agency to rapidly move toward
using a payroll-based system for reporting staffing levels, as opposed
to the flawed self-reporting mechanism currently in place.
“Finally, I agree with Administrator Weems that it
is critical that families understand that the very best way to choose a
nursing home is to visit it – more than once, with and without an
appointment. Invaluable information can be gleaned by simply speaking
with residents, their family members, administrators, and the state
long-term care ombudsman’s office.
“The need for a rating system of this kind was
discussed at an Aging Committee hearing last November, at which
Administrator Weems testified. I would be remiss if I did not thank him
again for coming before the Committee with an open mind, ready to
exchange ideas. I commend Administrator Weems today and, as always,
appreciate the opportunity to work together to improve our nation’s
nursing homes.”
Nursing Home Transparency and Improvement Act of
2008
Increases Transparency About Nursing Home
Ownership and Operations
● Enables the residents and the government to
know who actually owns the nursing home
● Strengthens accountability requirements for
individual facilities and nursing home chains including annual
independent audits for nursing home chains
● Improves Nursing Home Compare by including a
nursing home’s ownership information, the identity of homes in the
Special Focus Facility program, and links to inspection reports
● Provides more transparency on a nursing home’s
expenditures by requiring more detail about staffing expenditures in
cost reporting
● Brings uniformity and structure to the nursing
home complaint process by requiring a standardized complaint form and
complaint resolution processes that includes complainant notification
and response deadlines
● Provides for improved reporting of
payroll-based nurse staffing information so that apples-to-apples
comparisons can be made across nursing homes
Strengthens Enforcement
● Equips the Secretary with tools to address
corporate-level quality problems in nursing home chains by giving the
authority to develop a national independent monitor program specific to
multistate and large intrastate nursing home chains
● Provides greater protection to residents of
nursing homes that close by requiring advance notice of the closure as
well as the development of a transfer and relocation plan of residents
● Requires a study on the role that financial
issues play in poor-performing homes
● Requires a study on best practices for the
appointment of temporary management for nursing homes
● Authorizes demonstration projects for nursing
home “culture change” and for improving resident care through health
information technology
Improves Staff Training
● Improves staff training to include dementia
management and abuse prevention training as part of pre-employment
training
● Requires a study on increased training
requirements either in content or hours for nurse aides and supervisory
staff
Dec.
15, 2008
“When it comes to nursing home quality and
transparency, I firmly believe two things. First, that Americans should
have access to as much information about a nursing home as possible.
This information should include the results of independent safety
inspections; the health status of residents, which is closely tied to
the quality of services provided; the number of direct care staff
responsible for providing hands-on care; and basic information about a
home’s management and ownership.