What IMPACT Has Done for Nursing Home Five-Star Rating System
The Improving Medicare Post-Acute Care Transformation Act (IMPACT) was signed into law by President Obama on October 6, 2014. The IMPACT was created to improve the quality of care for home health care, nursing home, rehabilitation and long-term acute care hospital patients. These improvements are to be made using more efficient and accurate data collection and reporting methods.
The IMPACT is set to roll out in phases from now until 2022. One of the first improvements to be made was the heightened standard of the nursing home five-star rating system. The adjusted rating system caused nearly one in three skilled nursing centers to be reduced by one star, according to Provider Magazine.
Before the recalibration of the five-star rating system, about 80% of nursing homes received a 4- or 5-star rating in terms of quality measures. After the recalibration, only 49% achieved high-level scores, according to CMS. While this doesn’t look good on paper for post-acute facilities, the end result will be a greater commitment to improving care for patients and reinforcing trust in the five-star rating system.
Approximately 1.4 million people visited the Nursing Home Compare website last year to reference the five-star ratings and make decisions for themselves or loved ones. When the facility they chose delivers a level of care that is subpar compared to its score, patients and their families lose trust in the five-star rating system.
The nursing home five-star rating system has been calculated by three categories: onsite inspection results from certified officials, quality measure scores and level of staffing. As of January 2015, two measures for antipsychotic drug use have been added for consideration, quality assessment survey results are being taken in to account and quality measure standards have become more rigorous.
Additionally, IMPACT seeks to verify staffing levels reported by nursing homes. CMS is currently conducting a pilot test for this, according to the White House, and will roll out electronic verification nationwide next year. This process will review payroll quarterly to ensure facilities are able to provide adequate care.
A large part of the rating inconsistencies are due to data being self-reported by facility representatives. Verification of the reported data was also lacking, which will be strengthened by using outside sources to confirm accuracy. Each type of post-acute care facility has its own standardized way to submit its data, which must be done in a timely manner.
Further adjustments to the five-star rating system are scheduled to be made by 2016. One addition includes taking hospital readmission rates from nursing homes into account—an area in which the post-hospitalists at General Medicine specialize.
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