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Medicare Improves Its Nursing Home Ratings System

Published on Nov 3, 2014 at 8:28 am in Nursing Home Abuse.

The Centers for Medicare and Medicaid Services (CMS) has announced improved auditing procedures will be used to make its five-star rating system for nursing homes more reliable. The changes will take effect in January and address many of the concerns that have been raised about the rating system. 

In 2009, when the rating system was first put in place, 37 percent of homes earned a four or five star rating. By 2013, nearly 50 percent of homes rated four or five stars. Many critics have argued that companies have learned how to rig the ratings system. The main problem is that the system is ripe for rigging because much of the information comes from the homes themselves, without any review or auditing. 

The Medicare ratings are supposed to show a homes quality in the following three areas:

  1. Health Inspections rating – Using the three most recent and comprehensive (annual) inspections and inspections that resulted from complaints in the last three years. This is the only category of data that comes from an independent source.
  2. Quality Measures (QM) rating –QMs are based on clinical data by the nursing home.
  3. Staffing rating – Based on: 1) Registered Nurse (RN) hours per resident day; and 2) total staffing hours per resident day, as reported by the homes.

We previously wrote about the incentives that nursing homes use to manipulate the data. The Medicare ratings impact where doctors discharge patients from hospitals and influence insurers’ decisions about which nursing homes to include in their networks.  

Increased Auditing and Reliability

Starting in January, the New York Times reports, nursing homes will have to report their staffing levels quarterly, with an electronic system that can be verified with payroll data. Critics pointed out that under the current system, many homes have been accused of ramping up staffing just at reporting time and laying people off right after.

For the Quality Measures rating, Medicare is launching an audit program to check the accuracy of the reported data.

The system is adding in data about two additional measures of quality. The ratings in January are planned to include information about how many patients are being prescribed antipsychotic drugs. By 2016, the system is also planned to display data on staff turnover.

CMS officials said they have been testing an auditing system at the state level that they plan to expand. The program would include both random and targeted audits.