The 5-Star Quality Measure That’s Hurting Nursing Home Residents

As part of the list of nursing home reforms the Biden administration announced in February 2022, there was a focus on veering away from the 5-star quality measure that uses self-reported nursing home data. Instead, the administration is encouraging more accurate and verifiable information to be available for those choosing a nursing home. 

The 5-Star Quality Measure

One of the primary places where reviews are posted for nursing homes is the Centers for Medicare & Medicaid Services’ Care Compare website. This site posts reviews and information regarding the performance and quality of doctors, hospitals, nursing homes, and rehabilitation facilities and practitioners using a 5-star rating scale. 

The problem is that when the nursing homes are self-reporting data, specifically for the Quality Measure rating, the numbers can be skewed, and a high Quality Measure rating can mask lower ratings in other areas.

“A frequent refrain from nursing homes with overall poor ratings is that their Quality Measure (QM) rating is very high. Consumer Voice’s report reveals how nursing homes with 5-star QM ratings can have the lowest ratings in staff or health inspections, as the examples in our report demonstrate.”

The Quality Measure rating is based on “data on resident function and health status indicators from the Minimum Data Set (MDS) and also Medicare claims data” that the facility reports to CMS quarterly.

The End Result

As a result of this system, those looking to find a good facility are misled and made to believe that the facility is of good quality, even though the other metrics, like staffing and health inspection ratings, may be much lower than an acceptable standard. The bad ratings are overshadowed and ignored, leading to individuals being placed in care facilities that do not meet standards of care.

The Biden administration would like to change this system to one that has consumers review the quality of facilities and does not rely on facilities to self-report. 

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