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Supporting and Refining the Five-Star Quality Rating System for Nursing Homes


Highlights

  • The national Five-Star Quality Rating System for nursing homes needs refinement as nursing home practices change.
  • We continued to provide analytic, programming and clinical support to the Center for Medicare & Medicaid Services to develop new measures and refinements to the rating system methodology.
  • The data also show associations between nursing home characteristics and star ratings, including an inverse relationship between numbers of beds and quality ratings.
The Challenge

The Centers for Medicare & Medicaid Services (CMS) implemented the Five-Star Quality Rating System on the Nursing Home Compare website in December 2008 with assistance from Abt and a technical expert panel and input from consumer and provider groups. The rating system summarizes the quality of nearly 16,000 nursing homes. CMS calculates star ratings for three domains of nursing home quality:

1) health inspections results;
2) nursing staffing levels; and
3) quality measures (QMs).

But the system needs refinement over time as nursing home practices change.

The Approach

Abt continued to provide analytic, programming and clinical support to CMS in the development of new measures and refinements to the rating system methodology. Activities included:

  • Quantitative analyses and preparation of technical memos;
  • Developing a long-term strategic plan for the Nursing Home Compare website and the Five-Star Quality Rating System;
  • Conducting annual usability testing of the Nursing Home Compare website with consumers to assess their understanding of the data and its adequacy and accessibility; and
  • Developing new claims-based quality measures of hospitalizations and outpatient emergency department visits in addition to development of a measure of successful community discharge for public reporting on Nursing Home Compare and use in the rating system.
The Results

Almost half – 48.7 percent – of nursing homes had improvement in their overall rating, while 23.4 percent of nursing homes declined. The increase in nursing homes receiving an overall rating of four or five stars is due to improvements in both the QM and staffing domains. In particular, QM ratings have increased dramatically since the transition from MDS 2.0 to measures derived from the MDS 3.0 in July of 2012. The data also show associations between nursing home characteristics and star ratings. There is an inverse relationship between bed size and the overall quality rating and the inspections rating, and, to a lesser degree, the staffing rating. Non-profit nursing homes receive higher ratings than for-profit facilities. Hospital-based nursing homes perform better than freestanding nursing homes.