Medicare tries to make its stars shine brighter

Screen Shot 2014-10-07 at 7.14.15 PMIn an earlier post, we had mentioned that the New York Times exposed that many nursing homes have figured out how to game Medicare’s Five Star Quality Ratings System. CMS (the Centers for Medicare and Medicaid Services) has just announced improvements to the ratings system, which will be implemented next year. They attempt to address many of the issues highlighted in the Times’s piece, including manipulation of staffing schedules so that homes appear to have better patient-to-staff ratios.

Here are the highlights of CMS’s goals:

  • Nationwide Focused Survey Inspections: Effective January 2015, CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
  • Payroll-Based Staffing Reporting: CMS will implement a quarterly electronic reporting system that is auditable back to payrolls to verify staffing information. This new system will increase accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.
  • Additional Quality Measures: CMS will increase both the number and type of quality measures used in the Five-Star Quality Rating System. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are in use. Future additional measures will include claims-based data on re-hospitalization and community discharge rates.
  • Timely and Complete Inspection Data: CMS will also strengthen requirements to ensure that States maintain a user-friendly website and complete inspections of nursing homes in a timely and accurate manner for inclusion in the rating system.
  • Improved Scoring Methodology: In 2015, CMS will revise the scoring methodology by which we calculate each facility’s quality measure rating, which is used to calculate the overall Five Star rating.  We also note that sources independent of self-reporting by nursing homes already are weighted higher than self-reported components in the scoring methodology.

You can find the full release on CMS’s website. While you’re there, you may want to check out their list of acronyms, always useful when dealing with the government!