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NYT scrutinizes Medicare 5-star rating system

August 26, 2014
by Pamela Tabar, Editor-in-Chief
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Medicare’s five-star rating system for skilled nursing facilities is being called out again—this time on the front page of the New York Times (NYT) and just before Medicare introduces similar ratings for dialysis centers, home healthcare agencies and hospitals.

The Center for Medicare & Medicaid Services (CMS) five-star system, the backbone of the agency’s Nursing Home Compare website, has seen plenty of criticism over the years.

The NYT dove deeper into the three categories of data that make up the rating system—health inspections, staffing measures and quality measures—wading through the complex metrics used to calculate how many stars a long-term care (LTC) facility ultimately will receive.

The NYT article highlights what many in the industry have considered a glaring weakness in the rating system: two of the three categories involve self-reported data that may or may not be verified. Yet even the official government survey inspections aren’t a silver bullet, the article notes, because facilities often are able to find out the approximate date of the unannounced visit and may make adjustments to staff or cleanliness to improve their scores.

The “hotel-like” rating system itself can send a misleading message of confirmed quality, especially when the general public may not understand how the data are collected. The article used the example of a California rehabilitation facility that, like many other facilities, received a five-star rating from CMS despite being involved in state fines and personal lawsuits by families.

The facility’s executives say the lawsuits “could be attributed to a ‘very litigious marketplace’ in the Sacramento area,” the article notes. LTC facilities have the right to appeal state and federal fines and the survey citations that prompt them—and many do appeal successfully. But so many appeals are being filed that the caseloads of the administrative law judges are overwhelmed.

CMS makes no bones about the system’s context in its own description: “Caution: No rating system can address all of the important considerations that go into a decision about which nursing home may be best for a particular person. Examples include the extent to which specialty care is provided (such as specialized rehabilitation or dementia care) or how easy it will be for family members to visit the nursing home resident… Consumers should therefore use the Web site only together with other sources of information for the nursing homes (including a visit to the nursing home) and State or local organizations (such as local advocacy groups and the State Ombudsman program).”

Click here to read the NYT article.