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March 5, 2019
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CMS Improving Nursing Home Compare in April 2019
Changes offer greater support to consumers looking to compare quality of Nursing Homes
Today, the Centers for
Medicare & Medicaid Services (CMS) announced updates coming next month to
Nursing Home Compare
and the Five-Star Quality
Rating System to strengthen this tool for consumers to compare
quality between nursing homes. The April 2019 updates to Nursing Home Compare
are part of a broad range of updates that have been under development for the
last several years. The Nursing Home Compare website and
Five-Star Quality Rating
System were created to help consumers, their families, and
caregivers compare nursing homes and identify areas they may want to ask
about when looking at nursing home care. The updates further advance CMS’s
goals to improve the accuracy and value of the information found on the site
and promote quality improvement in nursing home care with the result of
better health outcomes for residents.
“CMS is committed to
safeguarding the health and safety of nursing home residents by ensuring they
are receiving the highest quality of care possible,” said CMS Administrator
Seema Verma. “Our updates to Nursing Home Compare reflect more transparent
and meaningful information about the quality of care that each nursing home
is giving its residents. Our goal is to drive quality improvements across the
industry and empower consumers to make decisions, with more confidence, for
their loved ones.”
Nursing
Home Compare has a quality rating system that gives each nursing home a
rating between 1 and 5 stars. Nursing homes with 5 stars are considered
to have above average quality and nursing homes with 1 star are considered to
have quality below average. There is one Overall 5-star rating for each
nursing home, and a separate rating for each of the following three factors:
CMS has periodically made
improvements to the website and ratings system. Each update has been part of
CMS’s ongoing effort to increase the accuracy of information available to
consumers and to drive quality improvement at nursing homes across the country.
In 2012, CMS enhanced the
design and usability of Nursing Home Compare while incorporating a
considerable amount of new information. In 2015, several improvements,
including measures on the use of antipsychotic drugs in the ratings’
calculation and adjustments to the quality measures and staffing ratings’
methodology created additional incentives for increasing the quality of care
at nursing homes. And, most recently, in 2018, CMS replaced the self-reported
staffing data with data collected electronically through the Payroll-Based
Journal (PBJ) system, which provides an unprecedented insight into the
staffing of nursing homes. CMS also announced future plans to improve the
website and ratings system, such as adding a measure of hospitalizations
among long-stay residents.
The April 2019 changes
include revisions to the inspection process, enhancement of new staffing
information, and implementation of new quality measures.
This includes a lifting of
the ‘freeze’ on the health inspection ratings instituted in February 2018.
CMS ‘froze’ the health inspection star ratings category after implementing a
new survey process for Long-Term Care facilities. Because facilities receive
surveys at different times, some facilities would have been surveyed under
the old process and others under the new process. Without placing a ‘freeze’
on health inspection star ratings, the facilities would have been scored
using two different evaluation processes making the outcomes misaligned and
the data inaccurate. CMS ‘froze’ the health inspection star rating score
until all nursing homes were surveyed at least once under the new survey
process for Long Term Care facilities. Ending the freeze is critical for
consumers. In April, they will be able to see the most up to date status of a
facility’s compliance, which is a very strong reflection of a facility’s
ability to improve and protect each resident’s health and safety.
Additionally, CMS is
setting higher thresholds and evidence-based standards for nursing homes’
staffing levels. Nurse staffing has the greatest impact on the quality of
care nursing homes deliver, which is why CMS analyzed the relationship
between staffing levels and outcomes. CMS found that as staffing levels
increase, quality increases and is therefore assigning an automatic one-star
rating when a Nursing Home facility reports “no registered nurse is onsite.”
Currently, facilities that report seven or more days in a quarter with no
registered nurse onsite are automatically assigned a one-star staffing
rating. In April 2019, the threshold for the number of days without an RN
onsite in a quarter that triggers an automatic downgrade to one-star will be
reduced from seven days to four days. CMS is also making changes to the
quality component on Nursing Home Compare that would improve identifying
differences in quality among nursing homes, raise expectations for quality,
and incentivize continuous quality improvement.
To provide further value
and remain consistent with CMS’s Meaningful Measures initiative the April
2019 Nursing Home Compare Update includes adding measures of long-stay
hospitalizations and emergency room transfers, and removing duplicative and
less meaningful measures. CMS is also establishing separate quality ratings
for short-stay and long-stay residents and revising the rating thresholds to
better identify the differences in quality among nursing homes making it
easier for consumers to find the right information needed to make decisions.
For more information and
to view Nursing Home Compare, visit: https://www.medicare.gov/nursinghomecompare/search.html
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Tuesday, March 5, 2019
CMS Improving Nursing Home Compare in April 2019
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