It seems the Centers for Medicare and Medicaid Services (CMS) has been paying attention. While the agency’s five-star rating system for nursing homes has always been the subject of a fair share of criticism, new concerns started gaining speed in the media within the past few months. At the beginning of September, we reported on criticisms surrounding the self-reporting measures and other practices leading some experts to say that they doubt the integrity of the rating system as a true barometer of quality of care.
IMPACT Act aims to improve quality ratings for skilled nursing facilities
On Oct. 6, President Obama signed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which aims to improve quality through increased transparency and standardized assessments in several areas surrounding critical care issues across skilled nursing facilities, home health agencies, long-term care hospitals, inpatient rehabilitation facilities, and other post-acute care (PAC) providers.
IMPACT will allow both payments and patient outcomes to be compared across these providers, fueling the development and public reporting of quality measures and facilitating the provision of new PAC payment models, to be presented to Congress by the Medicare Payment Advisory Commission (MedPAC), according to Long-Term Living Magazine.
New changes directly address recent criticisms
But in direct relation to the current five-star rating system used by CMS to grade skilled nursing facilities, there are some big changes coming, many targeted specifically at areas of concern recently addressed in the media. IMPACT, it’s worth noting, however, was first introduced back on June 26 and enrolled as a bill on Sept. 18.
Long-Term Living Magazine summarizes some of the changes that will occur as a result of the passing of the IMPACT Act of 2014:
- More quality measures will be added to the rating system, beginning in January 2015, including re-hospitalization rates and anti-psychotic drug use.
- Staffing data will be gathered directly from payroll records rather than through self-report.
- Scoring methods will be re-evaluated to ensure they accurately represent the quality of providers earning these ratings.
- A national auditing system will be rolled out to verify information reported through on-site visits.
New measures taken to verify formerly self-reported data, such as staffing ratios and staff turnover rates, are particularly welcomed by critics. Cheryl Phillips, MD, LeadingAge’s senior vice president of public policy and advocacy, tells Long-Term Living Magazine that staffing is one of the most accurate indicators of quality in long-term care settings.
Self-reported quality measures overshadow accuracy
In fact, it’s the self-reporting measures which the debate has primarily centered on in recent months. The controversy surrounding the hotly debated Medicare star-rating system heated up again after the U.S. Department of Health and Human Services Office of Inspector General released an August 2014 report finding that in a random sampling of 209 nursing homes, only 53 percent of allegations of elderly abuse, neglect, or exploitation are reported to federal agencies.
As self-reporting is currently the relied-upon method the CMS utilizes to gather data which determines a skilled nursing facility’s star rating, this naturally casts a shadow over the perceived accuracy of the ratings.
Sweeping changes to data collection and verification to begin in January 2015
While the improvements are expected to take at least one year to implement, consumers will begin to have access to more legitimate, verified data beginning in January. Nursing homes will begin reporting staffing ratios quarterly, and this information will be verified through payroll documents.
Also beginning in January, nursing homes will be rated on the percentage of residents:
- Receiving anti-psychotic drugs
- Re-admitted to a hospital
- Discharged (released) from nursing home care
Most importantly, the system will eventually provide consumers access to this deeper data, such as staff turnover rates and other quality measures. While the additional measures will begin to be incorporated in 2015, this new data won’t actually be reflected in nursing home ratings until 2016.
These changes represent an increasing demand among today’s savvier consumers for high-quality, independent data that provides a true standard metric for navigating the challenges in decision-making when it comes to placing an aging loved one in senior housing. This is the need SeniorHomes.com aims to address with the Best Senior Living Awards, an independent rating system for assisted living, independent living, and other senior housing options to provide families with a standard metric and valid, third-party ratings from experts to aid the decision-making process.