CMS Seeks Comments On Five-Star Rating System For Nursing Homes

On June 24, 2008, the Center for Medicare and Medicaid

Services (CMS) began to solicit public comment on its proposed

five-star rating system for nursing homes. Nearly 700 long-term

care providers, consumer groups, and others participated in the

CMS-sponsored "Open Door Forum," a national

conference call on the five-star rating system.

CMS will publish five-star ratings for nursing homes on the

agency's Nursing Home Compare website as of December 2008.

According to Thomas Hamilton, Director of the Nursing Homes

Survey and Certification Group at CMS, the purpose of the

five-star system is to simplify nursing home quality

information and make it available to consumers in an

understandable format.

This five-star initiative is the latest in CMS' ongoing

efforts to develop consumer-friendly information on nursing

home quality, i.e., the Nursing Home Compare Web site, which

provides information on individual measures of quality of care,

staffing; and survey inspection information. More recently, CMS

began publishing a Special Focus Facility (SFF) designation for

chronically underperforming nursing homes. Designed in part to

highlight superior facilities, the five-star rating system is

based on the research and analysis commissioned by CMS for the

Nursing Home Value-Based Purchasing Demonstration project.

Nursing Home Compare now includes: (1) nursing home

characteristics such as number of beds, type of ownership, and

whether or not the nursing home participates in Medicare,

Medicaid, or both; (2) quality measures such as percent of

residents with pressure sores and percent of residents with

urinary incontinence; (3) summary information from the most

recent state inspection of the nursing home; and (4) staffing

information on the number of registered nurses, licensed

practical or vocational nurses, and nursing assistants in each

nursing home.

The new five-star system will provide a composite nursing

home quality of care rating of one to five stars, which will be

calculated from existing data sources that are similar to, but

not exactly consistent with, those presented on Nursing Home

Compare. The health survey inspection component will be

calculated using the prior three years' survey data and

will reflect findings on deficiencies and substantiated

complaints. The quality of care component will be calculated

based on a subset of the 19 quality of care measures on the

Nursing Home Compare Web site, although CMS is still

considering which indicators...