CMS Improving Nursing Home Compare in April 2019
Changes offer greater support to consumers looking to compare quality of Nursing Homes

Today, the Centers for Medicare & Medicaid Services (CMS) announced updates coming next month to Nursing Home Compare and the Five-Star Quality Rating System to strengthen this tool for consumers to compare quality between nursing homes. The April 2019 updates to Nursing Home Compare are part of a broad range of updates that have been under development for the last several years. The Nursing Home Compare website and Five-Star Quality Rating System were created to help consumers, their families, and caregivers compare nursing homes and identify areas they may want to ask about when looking at nursing home care. The updates further advance CMS’s goals to improve the accuracy and value of the information found on the site and promote quality improvement in nursing home care with the result of better health outcomes for residents.

“CMS is committed to safeguarding the health and safety of nursing home residents by ensuring they are receiving the highest quality of care possible,” said CMS Administrator Seema Verma. “Our updates to Nursing Home Compare reflect more transparent and meaningful information about the quality of care that each nursing home is giving its residents. Our goal is to drive quality improvements across the industry and empower consumers to make decisions, with more confidence, for their loved ones.”

Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three factors:

• Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
• Staffing Levels: The staffing levels are the numbers of nurses available to care for patients in a nursing home at any given time.
• Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data.

CMS has periodically made improvements to the website and ratings system. Each update has been part of CMS’s ongoing effort to increase the accuracy of information available to consumers and to drive quality improvement at nursing homes across the country.

In 2012, CMS enhanced the design and usability of Nursing Home Compare while incorporating a considerable amount of new information. In 2015, several improvements, including measures on the use of antipsychotic drugs in the ratings’ calculation and adjustments to the quality measures and staffing ratings’ methodology created additional incentives for increasing the quality of care at nursing homes. And, most recently, in 2018, CMS replaced the self-reported staffing data with data collected electronically through the Payroll-Based Journal (PBJ) system, which provides an unprecedented insight into the staffing of nursing homes. CMS also announced future plans to improve the website and ratings system, such as adding a measure of hospitalizations among long-stay residents.

The April 2019 changes include revisions to the inspection process, enhancement of new staffing information, and implementation of new quality measures.

This includes a lifting of the ‘freeze’ on the health inspection ratings instituted in February 2018. CMS ‘froze’ the health inspection star ratings category after implementing a new survey process for Long-Term Care facilities. Because facilities receive surveys at different times, some facilities would have been surveyed under the old process and others under the new process. Without placing a ‘freeze’ on health inspection star ratings, the facilities would have been scored using two different evaluation processes making the outcomes misaligned and the data inaccurate. CMS ‘froze’ the health inspection star rating score until all nursing homes were surveyed at least once under the new survey process for Long Term Care facilities. Ending the freeze is critical for consumers. In April, they will be able to see the most up to date status of a facility’s compliance, which is a very strong reflection of a facility’s ability to improve and protect each resident’s health and safety.

Additionally, CMS is setting higher thresholds and evidence-based standards for nursing homes’ staffing levels. Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes. CMS found that as staffing levels increase, quality increases and is therefore assigning an automatic one-star rating when a Nursing Home facility reports “no registered nurse is onsite.” Currently, facilities that report seven or more days in a quarter with no registered nurse onsite are automatically assigned a one-star staffing rating. In April 2019, the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days. CMS is also making changes to the quality component on Nursing Home Compare that would improve identifying differences in quality among nursing homes, raise expectations for quality, and incentivize continuous quality improvement.

To provide further value and remain consistent with CMS’s Meaningful Measures initiative the April 2019 Nursing Home Compare Update includes adding measures of long-stay hospitalizations and emergency room transfers, and removing duplicative and less meaningful measures. CMS is also establishing separate quality ratings for short-stay and long-stay residents and revising the rating thresholds to better identify the differences in quality among nursing homes making it easier for consumers to find the right information needed to make decisions.

For more information view Nursing Home Compare.