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Government to Change How It Rates Nursing Homes

The federal government announced on Thursday that it was changing the way that it rates nursing homes, adjusting the curve that it uses to measure the quality of the communities to make it more difficult to earn four and five star ratings. Using the new guidelines, officials said that many nursing homes’ ratings will likely fall, but the information will not be made public until February 20.

Current Ratings System

Currently, nursing homes are rated on a one to five star scale on the website, Nursing Home Compare a widely used federal website that evaluates more than 15,000 facilities across the country. Unfortunately, the system relies heavily upon unverified information that resulted in notoriously poor nursing homes receiving top marks. Two of the three major criteria used in the current ratings system, staffing levels and quality measure statistics, were self-reported by the nursing homes and not audited by the federal government.

Last October, the government announced that nursing homes would be required to start submitting their staffing levels quarterly through a system that could verify its claims through payroll data. It also announced that it would initiate a nationwide auditing program geared towards checking quality measure statistics.

Changes to the System

Under the new system, the Centers for Medicaid and Medicare Services (CMS) expanded and strengthened its NHC-5 Star Quality Rating System. It did so by reevaluating and introducing the following revisions to the program:

Adding Two Quality Measures
These measures refer to the use of antipsychotic medication in nursing homes. One quality measure focuses on the use of these medications for short-stay residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome. The second quality measure looks at the continued use of these medications for long-term nursing home residents that do not have these conditions.

Raising Performance Expectations
This change broadly raised the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category.

Adjusting Staffing Algorithms
This change is focused on more accurately reflecting the staffing levels at the nursing homes. Under the new changes, nursing homes must earn four stars on either the individual registered nurse or the staffing categories to receive four stars in the Overall staffing rating. In addition, a facility cannot have less than a three star rating on any of those criteria.

Expanding Target Surveys
The final change institutes specialized, on-site surveys of nursing homes by the State Survey Agencies. They assess the adequacy of the resident assessments and the accuracy of the information reported to CMS that is used in the quality measures for the ratings system. A pilot study was done in five states in 2014 that will be available to the public on February 23.

Response to the Changes

Federal officials have stated that the purpose for the revisions is to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures areas. Representatives for the nursing homes have responded that they are worried that the changes will send the wrong message to the consumers. However, officials have contended that the changes would be explained fully on the website and that the public would be cautioned not to draw conclusions just because a nursing home’s star rating declined.

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