The federal government's new online rating system for nursing homes is getting mixed reviews since its unveiling last month.
Some watchdog groups and nursing homes -- especially those at the low end of the five-star system -- question its validity, while other industry groups and nursing homes welcome the new Web site as a valuable tool to help Americans faced with the difficult task of choosing a nursing home for family members, loved ones or themselves.
CMS -- which oversees Medicare and Medicaid, the two public insurance programs that pay for much of the country's nursing home care -- rates 15,800 nursing homes that participate in the public insurance system on its new Nursing Home Compare site. Based on data supplied by the nursing homes as well as state inspections, CMS assigns each nursing home a rating of one to five stars, similar to systems used to rate restaurants and hotels.
"More than three million Americans rely on services provided by a nursing home at some point during the year," said Kerry Weems, CMS acting administrator. "This should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision," Weems added.
As a whole, the nation's nursing homes didn't fare so well in the first month of ratings. Almost one in four (22%) earned the lowest rating of one star. At the other end of the spectrum, about one in 10 (12%) earned five stars. The remaining 66% of participating facilities were distributed fairly evenly among the two, three and four star rankings.
Ratings will be updated each month.
New Approach With Existing Technology
The new system is not a product of new technology -- CMS has had the ability to collect and display the data online for years. What's different is a combination of a new, more consumer-oriented approach and new techniques for crunching the numbers.
"This is a product of new computer modeling using existing data,” Weems said. "This data has been available for years online, but it can be difficult for families to understand all the aspects of a health inspection or staffing levels. We're hoping the five-star rating system will make all that data more useful, more approachable for consumers."
The new system reflects a relatively new Bush administration effort to offer more and better information on quality, comparisons and cost of care using data from Medicare and Medicaid.
The five-star rating system for nursing homes followed the government's first nationwide identification of chronically underperforming nursing homes. Last year, CMS launched a star rating system for health and prescription drug plans available to Medicare beneficiaries.
CMS officials said other consumer rating tools are in the works, but didn't specify what they might be.
Critics Say Take Stars With Grain of Salt
Critics of the new site say quality ratings are suspect because much of the data is reported by nursing homes themselves and unverified by any oversight agency.
CMS' reliance on state surveys also has been questioned. In a series of reports issued over the past 10 years, the Government Accountability Office says state surveys frequently understate deficiencies in nursing homes.
The National Senior Citizens Law Center recommends consumers use the new rating system with caution and only as an aid while also pursuing other information and strategies.
"Consumers need to understand that the five-star system is a beginning, not an end," Eric Carlson, director of the Long-Term Care Project of the National Senior Citizens Law Center, stated in a release.
"A nursing home's quality can shift from month to month, so consumers have to be savvy in asking the right questions and understanding the responsibilities of nursing homes under the federal Nursing Home Reform Law," Carlson said.
The American Association of Homes and Services for the Aging also cautioned against placing too much credence in the new system, calling it "poorly planned, prematurely implemented and ham-handedly rolled out."
"The five-star rating system is a great idea prematurely implemented," the Association said in a statement attributed to Larry Minnix, its president and CEO. "We support a consumer-friendly nursing home rating system based on reliable quality information that the public can understand."
The association suggests several ways to improve the five-star system:
- Immediate development of a data-collection tool around staffing;
- Coordination of the rating system with the Advancing Excellence in America's Nursing Homes campaign; and
- Overhaul of the survey and certification system with funding provided for a new system.
Not-for-Profit vs. For-Profit
The new online rating system makes it relatively easy to compare quality and safety of nursing homes using several categories such as geographic location, ownership and not-for-profit vs. for-profit.
One of CMS' goals with the new quality rating system is to encourage competition.
"We expect that nursing homes that find themselves at the lower end will use this as means of improving their quality," Weems said. But CMS, under its current leadership that believes in the free market approach to health care delivery, probably did not expect numbers to crunch this way: Not-for-profit nursing homes are more likely to provide better care than for-profit nursing homes, according to CMS data.
An analysis of the government data by USA Today showed 27% of the country's 10,542 for-profit homes earned one-star, compared with 13% of the 4,182 not-for-profit homes. On the high end, 19% of not-for-profit facilities got five stars, compared with 9% of for-profits.