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Beware Medicare Ratings for Nursing Homes

Published on Sep 2, 2014 at 8:47 am in Nursing Home Abuse.

It turns out that Medicare’s rating system for nursing homes is deeply flawed. A New York Times analysis has revealed that several of the factors are self-reported, unverified, and negative information, like complaints and state fines, are often not reflected.

Skewed Ratings?

Patients and families are not getting the whole picture and sometimes appear to be getting a distorted picture. The Medicare ratings – one to five stars – are supposed to reflect a home’s quality in three areas. The Medicare.gov website describes those categories as follows:

1. Health Inspections rating:
These ratings are based on the three most recent, comprehensive inspections annually, as well as inspections due to complaints in the last three years. We place more emphasis on the more recent inspections.

2. Quality Measures (QM) rating:
Combining the values of nine QMs (a subset of the 19 QMs listed on Nursing Home Compare) we create the QM rating. QMs are derived from clinical data reported by the nursing home.

3. Staffing rating:
We base the staffing rating on two measures: 1) Registered Nurse (RN) hours per resident day; and 2) total staffing hours per resident day. Total staffing includes: RNs; Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs); and Certified Nurse Aids (CNAs). Each facility submits staffing data, which are adjusted for the needs of the nursing home residents.

Only the Health Inspection data is from an independent source. While the definitions do state that the data for Quality Measures and Staffing are self-reported by the homes, the New York Times reports that those figures are “accepted by Medicare, with limited exceptions, at face value.”

Worse, the ratings do not reflect state fines and enforcement actions against nursing homes, consumer complaints, or lawsuits. The astounding finding from the Times was that of the more than 50 homes on a federal watch list for quality, two-thirds of those homes received four- or five-star ratings on quality and staff levels – because those ratings are based solely on self-reported data.

A California “Five-Star” Nursing Home?

The New York Times article used The Rosewood Post-Acute Rehab in Carmichael, Calif. as an example, Medicare had given Rosewood the highest possible rating — five-stars overall — yet only last year, the State of California had fined the home $100,000 (the highest penalty possible) for causing the 2006 death of a resident by giving her an overdose of a powerful blood thinner.

Further investigation, including interviews with current and former patients, families, and staff, revealed a different picture. Rather than the highest possible “five-star” image given by Medicare, it looks like this home has some of the same, troubling problems as so many other nursing homes: Many residents live three to a room; they often run out of basic supplies like washcloths, and there is a shortage of quality staff.

The Center for Medicare Advocacy, a nonprofit that advises Medicare patients, agreed with the findings that skewed data misrepresents many poor quality homes: “These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures.”

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Tad Thomas has dedicated his practice to representing plaintiffs in various types of civil litigation, including personal injury, business litigation, class actions, and multi-district litigation.

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