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Medicare Toughens Standards on Nursing Homes
New York Times
The star ratings of nearly a third of the nation’s nursing homes were lowered on Friday, as federal officials readjusted quality standards in the face of criticism that the ratings were inaccurate and artificially inflated.
Federal officials said they hoped the changes would make it easier for consumers to differentiate between facilities, as well as spur nursing homes to make improvements.
“You do need to raise the bar," Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services, told reporters. When it becomes relatively easy to achieve a high rating, he said, “that’s not going to incentivize the same level of improvement."
The changes that took effect on Friday were mainly aimed at one of three major criteria used to rate the homes on the Nursing Home Compare website, which ranks more than 15,000 nursing homes on a one- to- five-star scale. Officials essentially adjusted the curve for the quality-measures rating, which is based on information collected about every patient.
Representatives for the nursing home industry said that rather than helping consumers, the changes could frustrate them.
“Any time that nearly a third of an entire sector is impacted by a change of this magnitude, there will be confusion,” said Mark Parkinson, the chief executive of the American Health Care Association, the trade group for profit-making nursing homes. “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.”
Advocates for nursing home residents, however, described the changes as long overdue.
“We think that rescaling the quality measures will result in improved reporting of the quality of care a nursing home may provide," said Robyn Grant, director of public policy and advocacy at the group Consumer Voice.
Nursing Home Compare has become the gold standard for evaluating the nation’s nursing homes, even as it has been criticized for relying on self-reported, unverified data. The website receives 1.4 million visits a year, federal officials said.
In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate operations — staffing levels and quality measures statistics — were reported by the homes and not audited by the federal government.
In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate.
Before the change on Friday, about 80 percent of the nation’s nursing homes received a four- or five-star rating out of five on their quality measures score; afterward, nearly half did. The number of homes receiving one star in that area increased to 13 percent, from 8.5 percent, after the recalibration.
The changes led to declines in the quality-measures rating of 63 percent of homes. The staffing scores of about 13 percent of homes also fell because of other adjustments that took effect on Friday.
Federal officials said the higher bar reflected the fact that the industry had improved since December 2008, when the rating system was put into effect.
“We expect improvement over time," said Thomas Hamilton, the agency’s director of Survey and Certification, comparing nursing homes to the automobile industry. “Just like the Model A in its day was — I’m told — an excellent car, it wouldn’t measure up to today’s models.”