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Brookings Institute: Gaming 5-Star Rating System Very Likely


A new report from the Brookings Institute has concluded that a significant number of nursing homes likely fraudulently self-report data to the federal government which then is used to inflate their 5-star rating on the federal Nursing Home Compare website.

The report reviewed a number of data from nursing homes, including the three variables in a facility’s 5-star rating (staffing, quality measures, and inspection results), two of which are self-reported by nursing homes, and found strong statistical evidence that self-reported data is falsified to increase star ratings.  The authors found that the higher the financial incentives (based largely on local competition) a facility had, the more likely its self-reported data was to improve its star rating.  The authors further discovered that self-reported data did not correlate with onsite inspection results so that facilities with improved self-reported data did not have those improvements reflected in onsite inspections.  Finally the authors observed the number of complaints against a facility, a measure of true service quality, was closely correlated to onsite inspection results but not at all with self-reported data, providing strong evidence that self-reported measures are inflated.

The Brookings report is important in confirming what nursing home resident advocates have long known: nursing homes are gaming the 5-star rating system, misleading consumers and undermining the most popular tool for judging nursing home quality.  Onsite inspection reports and the number of complaints are much more important than self-reported staffing and quality measure data.