Providers Blast Changes to Nursing Home Quality Ratings

A huge number of skilled nursing facilities will have their reputations unfairly jeopardized and consumers likely will be confused by new changes in the government’s quality rating system for nursing homes, provider associations argued today after the controversial reforms officially were announced.

Since 2008, the federal government has rated SNF quality using a five-star system, with five stars being the highest rating possible. About one in three providers will lose a star under the reconfigured ratings, which go into effect immediately, the Centers for Medicare & Medicaid Services acknowledged in announcing the new system. Two-thirds will receive lower quality measures under the new system.

This statistics were confirmed by the American Health Care Association/National Center for Assisted Living, the nation’s largest long-term care provider association. AHCA/NCAL confirmed that an estimated 4,777 of 15,500 centers nationwide stand to lose at least one star. The organization blasted the move from CMS, saying it will appear quality has declined when that has not in fact occurred.


“We’re not helping patients and their families get the information they can trust when the star rankings don’t match the quality care being delivered,” stated AHCA/NCAL President and CEO Mark Parkinson. The ratings are available online and are meant to help consumers choose a provider.

The newly unveiled changes are likely to demoralize skilled nursing facility workers, according to LeadingAge, which represents about 6,000 not-for-profit senior care and services organizations. In a press release, LeadingAge posed the question, “What are employees supposed to feel when, despite their best efforts, their nursing home suddenly appears mediocre rather than excellent?”

The star ratings have been criticized by providers and other long-term care stakeholders since their initial implementation, and the system has been overhauled once already. The ratings drew renewed scrutiny from federal lawmakers after a scathing New York Times article in August 2014. Much of the information used to determine the ratings is self-reported by providers, raising questions about accuracy, the Times claimed. The article also focused on the fact that nursing home staffing levels are not verified by payroll data.


An adjusted staffing algorithm is part of the changes announced Friday. Another key update: The number of short-stay and long-stay residents taking antipsychotic medication for off-label purposes, such as controlling dementia symptoms, will now be considered in determining a facility’s star rating. Nursing homes have reduced antipsychotic prescribing in recent years through a concerted effort undertaken in partnership with CMS.

All the major five-star changes are summarized in a CMS fact sheet.

“The changes in ratings reflect that CMS raised the bar for performance that should be recognized as high quality and anticipates nursing homes will make quality improvements to achieve these higher standards,” the agency stated. It conceded that the loss of stars does not mean that quality at those facilities actually has declined. It also announced that a further substantial overhaul to the rating system will occur in 2016.

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Some consumer advocates praised CMS, saying the reforms will address some of the issues raised by the New York Times and others.

“We hope these changes are a wakeup call for nursing homes that it is going to become harder to hide behind erroneous data if they are providing bad care to residents and that the changes will make it easier for consumers to evaluate individual nursing homes,” stated Patricia L. McGinnis, executive director of California Advocates for Nursing Home Reform (CANHR), in a press release issued Friday.

Written by Tim Mullaney

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