The CMS is making it more difficult for nursing homes to get high marks on a five-star rating system meant to help consumers and families compare quality among facilities in a given state. The agency is adding two additional measures to the rating calculation, as well expanding onsite surveys and using an electronic reporting system to verify staffing levels.
The CMS has “raised the bar for performance,” said an announcement Thursday. “When progress is achieved, CMS resets the distribution to promote further progress." Updates will be posted to the Nursing Home Compare website Feb. 20.
Five-star ratings for nursing homes were first posted in 2008, but have recently come under fire. For example, a report from the New York Times last August revealed how some nursing homes with poor quality still received four and five stars under the program.
The CMS said Thursday it will expand use of state survey agencies to conduct specialized, onsite visits of a sampling of nursing homes to assess the accuracy of the quality information reported. Results of a pilot study of the survey program, conducted in five states in 2014, will be posted Feb. 23.
Also implemented are adjustments to ratings associated with staffing levels for registered nurses, licensed practical nurses and certified nursing assistants. Facilities are now expected to reach at least 3-stars on certain aspects of those dimensions. Ensuring adequate staffing levels has been shown to reduce medication errors and decrease patient complications and mortality, according to the American Nurses Association.
Calculations now will include two quality measures related to the appropriate use of antipsychotic medications in short- and long-stay residents who do not have schizophrenia, Huntington's disease and Tourette syndrome. Elderly patients with dementia have traditionally been prescribed antipsychotics to control difficult behavior, even though they do not have a diagnosis of psychosis.
In 2012, the CMS established a public-private alliance to focus on dementia care. Last September the alliance said it had seen a 17.1% reduction in the national overuse of antipsychotics in nursing homes by the first quarter of 2014 and that it would continue to push for better outcomes. The CMS anticipates a 30% reduction by the end of calendar year 2016.
“We're glad CMS is addressing the problem,” said Janet Wells, a consumer advocate and public policy consultant based in Washington, DC. “Overuse of antipsychotics is an indicator of poor care, and addition of these measures will bring that to the attention of a lot of facilities that have not addressed the problem.”
The announcement comes as the CMS continues to roll out similar five-star ratings programs as part of a greater push to increase transparency and help Medicare beneficiaries compare quality among providers.
Ratings were applied to more than 5,500 dialysis facilities in January amid criticism from kidney care groups, and to more than 10,500 Medicare-certified agencies home health facilities in December.