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CMS Changes Rating System for Nursing Homes

By Rebecca Adams, CQ Roll Call

February 12, 2015 -- Medicare officials announced Thursday that they will overhaul the quality rating system for nursing homes and the federal website that compares the facilities.

Nursing home industry lobbyists were worried that Centers for Medicare and Medicaid Services (CMS) officials would change the way that the quality of care was measured. Those concerns were validated by the announcement.

“The changes in ratings reflect that CMS raised the bar for performance that should be recognized as high quality and anticipates nursing homes will make quality improvements to achieve these higher standards,” CMS officials said in a statement. “However, the changes in the quality measures star ratings released in February do not necessarily indicate a change in the quality of care provided.”

The nursing home industry said that the public may not realize that the scores are being calculated in a new, more demanding way, and will mistakenly believe that a nursing home’s quality has dropped suddenly.

“We are concerned the public won’t know what to make of these new rankings,” said Mark Parkinson, President and CEO of the American Health Care Association, a trade association.  “If centers across the country start losing star ratings overnight, it sends a signal to families and residents that quality is on the decline when in fact it has improved in a meaningful way.”

The Obama administration wants to reduce the inappropriate use of antipsychotic drugs, so the agency is adding a quality measure that tracks the use of the drugs for residents who stay in a facility for a short period of time, and another that tracks the use for long-term residents. CMS officials said on a call with nursing home operators that the homes would not be penalized for giving a short-term patient the drugs if the person came in using the drugs under a doctor’s direction, but that the administration would not want to see a greater use of the drug after the person is admitted. Patients with a need for the drugs, such as those diagnosed with schizophrenia, Huntington’s disease, or Tourette syndrome, are excluded.

Medicare officials also are making it harder for nursing homes to win the highest ratings on a five-star scale. The overall rating is based on a formula, and nursing homes will have to get a higher number of points on that formula than in the past to maintain high overall scores.

Nursing homes also will have to meet new standards on their staffing levels. Operators of some nursing homes have been accused of trying to game the system. Under the new system, nursing homes have to earn a high rating on one of the staffing measures and must get at least a 3-star rating on all of the staffing level ratings in order to  win an overall rating of 4 stars or better.

The Nursing Home Compare website is one of several web pages that CMS officials administer in order to give the public a comparison of the quality of different institutions. The five-star quality rating system was added in 2008. The Nursing Home Compare website gets more than 1.4 million visitors per year, according to CMS officials.

The changes were announced in a public call on Thursday and in a statement.

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