Following through on its announcement last June, the Centers for Medicare and Medicaid Services (CMS) has updated its Nursing Home Compare website to include a quality rating system that assigns from a low of one to a high of five stars to each of the 15,800 nursing homes in the United States that participate in Medicare or Medicaid.

Results for a New Hampshire nursing home.

“Our goal… is to provide families a straightforward assessment of nursing home quality, with meaningful distinctions between high and low performing homes,” said CMS Acting Administrator Kerry Weems.

CMS developed the rating system–with input from academics and various stakeholder groups–to evaluate nursing homes in three core areas: health inspection surveys, quality measures, and staffing information. A star rating is supplied for each of the three areas, as well as a composite or overall score (see graphic).

Consumer groups such as NCCNHR have offered praise (pdf) for the new system and encouraged the use of star ratings when choosing a nursing home, while provider groups like AAHSA have voiced serious concerns over the legitimacy of the data and the manner in which the system was rolled out.

PHI policy director Steven Edelstein acknowledges the rating system has weaknesses and notes that it is still too early to assess its implementation, but applauds CMS for including staffing levels as a key measure of quality, a move that is in line with PHI’s position statement on Quality Assurance (pdf).

Edelstein would like to see them go even further: “Turnover is a serious problem in nursing homes that disrupts caregiving relationships and undermines the quality of care,” says Edelstein. “Turnover rates and factors directly affecting turnover like wages and benefits should be included in the rating system, especially in regard to direct-care workers who provide 70 to 80 percent of hands-on care.”

In this first round of quality ratings, about 12 percent of the nation’s nursing homes received a full five star rating while 22 percent scored at the low end with one star.  The remaining 66 percent of facilities were distributed fairly evenly among the two, three, and four star rankings. CMS says that rankings are dynamic and will be updated monthly

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