On February 12, 2015, the Centers for Medicare & Medicaid Services (“CMS”) announced revisions to its often-criticized system of rating nursing homes in the United States, which prospective nursing home residents and their families may rely on in selecting nursing home care. CMS described the newly announced revisions as “an expanded and strengthened NHC 5-Star Quality Rating System for Nursing Homes on the CMS Nursing Home Compare website.” CMS reports that its website receives more than 1.4 million visitors per year and that 85% of website users reported that they found the information they were looking for on nursing homes.
CMS’ “Nursing Home Compare” 5-Star Quality Rating System is based on data obtained from onsite inspections conducted by CMS and state public health departments, “quality measures” based on information obtained from nursing homes regarding the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls, inter alia, and nursing home staffing levels as reported by the nursing homes themselves.
Critics of CMS’ nursing home rating system cite CMS’ reliance on nursing homes self-reporting of critical information on which CMS bases its awarding of its coveted four-star or five-star rating – if the information provided by nursing homes on which they are rated is false, then the nursing homes may be rated higher than they objectively deserve. Higher ratings than justified result in those relying on the CMS ratings to base their nursing home selection decision on false or wrong information, which may lead to inadequate care, avoidable nursing home injuries, or other serious harms.
The New Revisions
CMS is adding two “quality measures” (QMs) for antipsychotic medication use in nursing homes to the 5-Star calculations: one of the two added quality measures is for short-stay residents when a nursing home begins use of antipsychotics for people without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome; and, the second added quality measure reflects continued use of such medications for long-stay nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
Another revision being made by CMS is adjusting the nursing home staffing algorithms that it uses to more accurately reflect staffing levels: nursing homes must earn 4-stars on either the individual Registered Nurse (RN) only or the staffing categories to receive 4-stars on the Overall staffing rating and can have no less than a 3-star rating on any of those dimensions.
CMS also intends to raise performance expectations by raising the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category on its website.
CMS plans to expand targeted surveys of nursing homes by having state survey agencies conduct specialized, onsite surveys of a sample of nursing homes across the U.S. that assess adequacy of resident assessments and the accuracy of information reported to CMS that is used in calculating quality measures used in the rating system.
CMS plans to implement a quarterly electronic reporting system that is auditable back to payrolls to verify staffing information that 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.
If you or a loved one were injured (or worse) as a result of nursing home negligence, nursing home abuse, or nursing home neglect in the United States, you should find a nursing home claim lawyer in your state who may investigate your nursing home claim for you and represent you or your loved one in a nursing home negligence case, if appropriate.
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