Those pesky nursing home ratings. It's a five-star rating system implemented by the Centers for Medicare and Medicaid Services in 2008, and it's had its share of critics over the past few years. Yet again, the nursing home rating system is making news -- as it does every year when ratings are updated.

Heavy criticisms

Early concerns about the rating system include whether the quality measures facilities are rated on are actually correlated with resident and family satisfaction. Providers expressed concern that ratings painting an inaccurate picture could influence consumer decision-making, hitting the bottom line of many facilities that do -- in theory -- actually provide quality care.

And the problems don't end there. According to Long-Term Living magazine, 31 states composed a group letter to Kathleen Sebelius, Health and Human Services Secretary, bringing to light a potentially serious flaw in the rating system: That facilities are grouped by state, and therefore can't be compared across state lines. Further, the rating system requires that 20 percent of facilities are given the lowest rating (one star) and just ten percent are given the best (five stars). In other words, a low-rated facility in one state could actually be providing the same level of quality care as a facility just an hour away, across a state line.

[caption id="attachment_28031" align="alignright" width="300" caption="Image by svilen001 on Stock.xchng"]Medicare's 5-Star Rating System[/caption]

Low ratings are tough to overcome

Clinical outcomes measures are currently on hold during the switch to MDS 3.0. The new quality measures are set to be announced in April 2012, but some still say a larger issue remains. Mansfield News Journal reports on problems with the current system; primarily, that once a facility has been given a one-star rating, it's nearly impossible to ever improve its ranking.

In an analysis of federal data, USA Today found that on average, about 1 in 25 nursing homes nationwide has consistently received a one-star rating across the seven current quality measures since the program's implementation in 2008. In some states, the proportion is even higher, with as much as Louisiana and Pennsylvania which each have 8 percent of facilities with a single-star rating.

Overall findings are ambiguous Overall, the analysis showed that quality as a whole is on the rise. For instance, the number of facilities receiving one- or two-star ratings dropped from 40 to 35 percent in 2009, and the overall percentage of facilities receiving four- or five-star ratings rose from 38 to 43 percent.

However, a look at the data another way shows an area of concern: There are more facilities consistently receiving the lowest ratings (564) than there are those who are consistently achieving five-star ratings (448).

In response to consistent low ratings, HCR ManorCare points out that the 5-Star Rating System doesn't incorporate data to weigh the high proportion of complex patients with multiple conditions.HCR ManorCare operates approximately 277 facilities across the U.S., 22 of which have been consistently rated with just a single star since 2008. None of HCR ManorCare's 277 facilities has been a consistent five-star performer.

Is staff retention the solution?

Some states, such as Ohio, have incorporated programs to help facilities with single-star ratings make quality improvements like reducing staff turnover, a strategy said to improve resident satisfaction and reduce the likelihood of errors.

Industry groups are advocating for more comprehensive ratings when the system is updated, including more measures for staff turnover and retention. Whether these recommendations will result in a more accurate and reliable ratings system is unclear, but several experts point out that it's not wise for consumers to rely solely on a rating system to make an informed decision.