Medicare’s 5-Star Rating System Under Fire

Medicare’s star-rating system for nursing homes, dubbed Nursing Home Compare, is no stranger to controversy. On its launch in 2008, the long-term care community was up in arms, criticizing the system’s lack of quality metrics that play a key role in resident satisfaction. And a new report by a major newspaper has brought critiques of the system back into the forefront.

New criticisms emerge pointing to flawed ratings

According to a recent article in The New York Times, “The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify.”

The article points out that only one of the metrics used to determine a nursing home’s star rating comes from independent reviewers: state inspection data. Staffing ratios and quality measures are self-reported by skilled nursing facilities (SNFs), opening the door for potential abuse of the system.

Criticisms of Nursing Home Compare are nothing new; the program has faced them since its inception. But the content of the complaints has changed course over the years.

Early criticisms of Nursing Home Compare

The American Health Care Association (AHCA) denounced Nursing Home Compare in a public statement, voicing the view that the program “is premised upon a flawed survey system that does not measure quality, lacks the inclusion of other important quality elements that help consumers make informed decisions, and includes inaccurate data.”

The general consensus was that nursing homes could be unfairly portrayed or perceived as providing a lower quality of care, based on technicalities that resulted in deficiencies on state inspections. In other words, a lower five-star rating could be assigned to a skilled nursing community that provides exceptional care, and providers were concerned that they’d lose potential residents as a result of such inaccurate ratings.

Nursing Home Compare

 

Ratings lack critical state complaint data

What’s more, Nursing Home Compare does not take into account complaints filed by consumers with state agencies or fines and other enforcement actions by individual states, only federal actions. The Times points to one community, Rosewood Post-Acute Rehab, a nursing home in a Sacramento suburb, which has maintained a perfect five-star rating for five years, a distinction held by just one-fifth of all nursing homes in the U.S.

But what this rating doesn’t disclose to consumers is the fact that Rosewood was fined $100,000 in 2013, the highest penalty possible, for an accidental, and unfortunately fatal, overdose in 2006. It also doesn’t tell consumers that there have been more than 100 complaints filed in California against this particular nursing home between 2009 and 2013.

California Advocates for Nursing Home Reform, an organization which also tracks complaints, has documented 164 complaints for the same time frame against Rosewood. Officials from Rosewood point out that only a small portion of those complaints have ever been validated, but according to The New York Times, experts say that merely being the subject of that number of complaints is a sign of potential trouble.

But consumers need a clear metric for comparison

While there are some changes coming that will hopefully improve the validity of the Nursing Home Compare rating, such as the requirement that Medicare use payroll data to verify reported staffing levels (required under the Affordable Care Act), a process and system for doing so hasn’t yet been finalized. Best Senior Living Awards Winner Badge

Perhaps of major concern is the idea that a standard, industry-wide rating system is such a valuable metric for consumers. It provides a single point of comparison to help families wade through what can otherwise be a confusing and overwhelming decision-making process. That’s why SeniorHomes.com has created the Best Senior Living Awards, an independent, third-party rating system for assisted living, independent living, and retirement communities.

The Best Senior Living Awards rating system utilizes the opinions of independent senior living experts, along with reviews from residents, staff, and family members, and other quantifiable metrics like state inspection data, to calculate a standard score that consumers can use to easily compare their top communities. Additionally, written reviews are publicly available on SeniorHomes.com, providing consumers with in-depth opinions from others with real-world experience with these communities. Visit any community’s profile on SeniorHomes.com, such as Dunwoody Pines in the Greater Atlanta, Georgia metro area, and access reviews submitted by residents, family members, and staff. And, if you have experience with a senior living community and would like to share your opinion with seniors and their families searching for senior housing options, visit our Post a Senior Living Review page to search for the community and submit your review.

There’s so much information out there about senior living options, yet the choice isn’t an easy one for seniors or their families. There’s a clear need for an independent, third-party rating system that provides a clear, straightforward rating taking into account both quality and compliance, quantitative and qualitative data. And that’s precisely what SeniorHomes.com aims to achieve.

Nursing Home Compare screenshot via Medicare.gov

Tags: , , ,

Leave a Reply