Government Accountability Office Issues Recommendations for CMS Nursing Home Rating System

Choosing the appropriate nursing home for a loved one is not an easy process. Our Illinois nursing home attorneys often suggest that the Centers for Medicare and Medicaid’s Five Star Rating System is an important resources in the selection process. The rating system uses a variety of factors to issues a rating (1-5 stars) for virtually all homes in the country. In addition, searchers can discover various ratings for each home on individual variables, such as nursing staff levels, citations, and similar factors. This is invaluable information that provides a general picture to help families make choice about what facility will provide the best care for their loved one. Ensuring a loved one does not fall victim to nursing home neglect and abuse begins with picking the right facility.

The CMS rating system is an important tool. However, there may be ways that the system can be improved so that it serves consumers in even better ways. Toward that end, the Government Accountability Office recently conducted a study that sought to understand how the current CMS system was created and what changes, if any, should be implemented to improve the project. A summary of the GAO findings can be read here.

The GAO report was required by the Patient Protection and Affordable Care Act. The report examines the methodological determinations that were made initially and whether those determinations should be altered. The study involved review of CM documents, interviews with officials at CMS, and general strategic assessments.

The report explains how the Five Star Rating System was developed over an 8-month period in 2008. It was crafted by a CMS contractor and members of an expert panel. That expert panel included nine stakeholders representing a cross-section of those in the long-term care industry. One important methodological decision made by this group when crafting the program involved the process by which the scores on each rating component would combine to create the overall rating (1-5 stars). Of course, this is a particularly important point because the most high-profile data point for each nursing home is its total number of stars.

The GAO report noted that CMS officials have a process in place to modify the rating methodological. Changes can be made is a few ways. Stakeholders can challenge the current methodologies, problems might be noticed in routine monitoring, or changes might be made when new data becomes available. However, only minor modifications have actually been made to the system in the four years that it has been around.

That may change in the future. CMS officials explain that alterations might be made soon relating to the system’s usability, revising the staffing evaluations, adding facility capability information, and adding more quality measures. Yet, the GAO study explained that there was a lack of strategic planning to coordinate these potential revisions to the system. That is why the report suggested that CMS use milestones and timelines to help implement these possible improvements. In addition, the GAO report suggested that CMS officials need to better explain how the implementation of these changes will actually help the group better meet their goals.

The Chicago nursing home lawyers at Levin & Perconti appreciate the important role that the CMS Five Star Rating System plays in long-term care decisions for local families. Hopefully the GAO recommendations work to improve the already beneficial consumer resource. If you or a loved one is in the process of deciding what deciding what facility is best, be sure to take a look at the CMS Nursing Home Compare website as an important starting point.

See Our Related Blog Posts:

New Medicare Website Provides More Resources for Consumers

Resources for Choosing a Nursing Home in Illinois

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