The CMS is making it more difficult for nursing homes to get high marks on a five-star rating system designed to help consumers and families compare quality among facilities in any given state.
The agency announced Thursday that it is adding two additional measures to the rating calculation, as well as expanding on-site surveys and using an electronic reporting system to verify staffing levels.
The CMS has “raised the bar for performance,” according to the announcement. “When progress is achieved, CMS resets the distribution to promote further progress,” the agency stated. 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.
The CMS said it will expand its use of state survey agencies to conduct specialized, on-site visits of a sampling of nursing homes to assess the accuracy of quality information reported. Results of a pilot study of the survey program, conducted in five states in 2014, will be posted Feb. 23.
The CMS also implemented adjustments to ratings associated with staffing levels for registered nurses, licensed practical nurses and certified nursing assistants. Facilities are now expected to attain at least three 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 additionally 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 or 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 in the drugs' use by the end of 2016.
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.