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Will Changes to Five-Star Rating System Bring Improvement?

five-star rating system patient improvementsAs of 2014, there were 15,800 nursing home facilities caring for approximately 1.4 million residents in the United States, according to the Centers for Medicare and Medicaid Services (CMS).

Of the entire U.S. population, 0.9% age 65-74, 3.2% age 75-84 and 11.2% over the age of 85 reside in nursing facilities, according to the U.S. Census Bureau. As the 76.4 million baby boomers continue to age, those percentages will only increase.

When deciding on a nursing home, how do you choose the best one?

In 2009, CMS created the Five-Star Quality Rating System for nursing homes. This system was intended to ease the long-term care decision making for patients, their families and their caregivers.

The five-star rating system measures an overall quality rating, as well as three individual areas including:

  • Health Inspections: conducted by the state health department and consisting of information from the last three years of on-site inspections and surveys.
  • Staffing: self-reported data measuring the level of facility staff.
  • Quality Measures (QM): self-reported physical and clinical patient assessments compared to fixed levels.

While the mentality was appropriate, the system was not without its flaws. Many are weary of the heavy reliance on self-reporting, in fear that the results are ultimately overstated and may omit negative information.

Improving the Five-Star Rating System

In its latest attempt to enhance the five-star rating system, CMS established additional guidelines that were initiated January 2015:

  • National Survey Inspections: conducted by CMS and state, this will confirm the reported level of performance on patient assessment and quality measure claims.
  • Staffing Payroll Monitoring: quarterly reports will confirm the reported staffing levels and hours of care patient care are accurate and up to standards. The amount of staff turnover at the facility will also be taken into account.
  • Quality Scoring: data that has been verified by outside sources will be relied on more heavily that self-reported data from facilities.
  • Additional Quality Measures: the first QM addition takes into account the amount of antipsychotic drug use at the facility.
  • Timely and Accurate Inspections: CMS is increasing requirements on the timeliness and accuracy of inspecting nursing homes, which will be taken into account.

There’s also a strong push for the extended use of technology in post-acute care facilities. In 2010 a bill was passed requiring nursing home data to be submitted electronically, yet many facilities still submitted their data via a printed form. Technology has become such a high priority that in October 2014, President Obama signed the Impact Act, putting $11 million in funding towards electronic collection systems. The bill also requires inspection of hospice facilities at least once every three years.

In 2009, at the start of the five-star rating system, 37% of nursing homes received 4-5 star ratings. By 2013, that number grew to nearly 50%. But, the real question is: will these new five-star quality measures force facilities to improve the quality of care and more accurately report information?

Between the added regulations and the push for advanced technology, many facilities could be left at risk. Regulations are put in place to identify areas of weakness and hold facilities accountable. While regulations are also meant to encourage improvement, a line needs to be drawn when, as facilities consistently operating at substandard levels should not be providing care.

Don’t fall behind on the changing standards—put General Medicine, The Post-Hospitalist Company’s team of professionals to work at your facility. Contact us today and together we’ll continue improving the quality of care for all.

Tom Prose

CEO at General Medicine, P.C.
As founder and CEO of General Medicine PC, the nation’s premier post-hospitalist care company,Tom Prose leads an exceptional team of internal medicine, geriatrics and healthcare administration specialists.