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CMS Unveils New Rating System for Nursing Homes

By Reed Cooley, CQ Staff

June 18, 2008 -- The Centers for Medicare and Medicaid Services (CMS) has announced a new five-star rating program for nursing homes that it hopes will aid America's elderly and their families in choosing the right place for end-of-life care.

"Getting information about the quality of a particular nursing home should not have to be like going through bureaucratic water torture," Sen. Ron Wyden said in a Wednesday press teleconference announcing the program. Wyden, an Oregon Democrat, serves on the Senate Special Committee on Aging.

The program, to be implemented in December, will work to improve the Nursing Home Compare section of the Medicare Web site by adding a five-star rating system, based on 19 quality measures, to information on the size, location, ownership, and coverage options of each nursing home.

"We know the public is hungry for information," Acting CMS Administrator Kerry Weems said at the teleconference. "Transparent information is an effective incentive for quality," he added.

Industry representatives agreed but cautioned that it is too soon to tell whether CMS' proposed system will be effective.

"We hope that a rating system would improve the quality of nursing home care, but we are concerned that in the time frame that CMS has outlined they're not going to be able build a stable, solid house to do that," said Lauren Shaham, a spokeswoman for the American Association of Homes and Services for the Aging (AAHSA).

In a statement anticipating the CMS announcement, AAHSA President and CEO Larry Minnix advocated the building of a rating system on "four essential pillars": resident and family satisfaction; staff satisfaction; clinical quality outcomes; and public oversight.

Both Minnix and Shaham stressed the importance of public oversight in the rating process. The public oversight pillar "will be the most controversial because [it] is the most developed, yet has the largest cracks in its foundation," Minnix said.

Tony S. Edelman, a senior policy attorney at the Center for Medicare Advocacy, worried that effective oversight would be difficult. "Two of the three criteria that CMS plans to use—quality measures and staffing data—are self-reported by nursing facilities and are inaccurate," he said.

The CMS announcement garnered a more hopeful reception from the powerful senior lobby AARP. "The star rating system proposed today could make it easier for families to identify facilities that consistently provide quality service and safety for their residents," AARP Executive Vice President John Rother said in a statement.

During the same teleconference, CMS separately unveiled an initiative to require all nursing homes serving Medicare and Medicaid beneficiaries to install sprinkler systems in their facilities by 2013.

The project will be phased-in in stages and is part of CMS' effort "protect the lives of our beneficiaries," according to Weems.

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