In an effort to improve quality health and clinical standards, Medicare is now rating nursing homes (NH) like hotels.  The Centers for Medicare & Medicaid Services (CMS) has enhanced its Nursing Home Compare public reporting site to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid.  The goal of the system is to continue to provide residents and their families with an easy way to understand assessment of nursing home quality, making meaningful distinctions between high and low performing nursing homes.  In other words, CMS is trying to push residents and families to make admit decisions based upon quality of care rather than…who’s got the best bird cage.

The rating system features an overall five – star rating based on facility performance for three types of performance measures, each of which has its own associated five star rating:

1. Health Inspection – Measures on outcomes from State health inspections:  Based upon scope and number of deficiencies during the most recent annual inspection surveys as well as significant findings from the most recent 36 months of complaint investigations.
2. Staffing – Measures based on NH staffing needs and current levels: Based on two main measures: 1) RN hours per resident day; and 2) total staffing hours (RN, LPN and nurse aide hours) per resident day.  These measures are obtained from CMS On-line Survey and Certification Reporting (OSCAR) system, and are case – mix adjusted based on the distribution of MDS assessments by RUG – III group.
3. QMs – Measures based on MDS quality measures (QMs): These are selected performance metrics on 10 of the 19 QMs that are currently posted on Nursing Home Compare web site.  Below are the set of measures for Long and Short stay residents:

1.  
   1. Long Stay Residents

·         Percent of residents whose need for help with ADL’s has increased

·         Percent of residents whose ability to move about in and around their room got worse

·         Percent of high risk residents who have pressure sores

·         Percent of residents who had a catheter inserted and left in their bladder

·         Percent of residents who were physically restrained

·         Percent of resident with UTIs

·         Percent of residents with moderate to severe pain

1.  
   1. Short Stay resident

·         Percent of residents with pressure ulcers (sores)

·         Percent of residents with moderate to severe pain

·         Percent of residents with delirium

Whereas before most skilled nursing home facility decisions were made based upon residents proximity to home and / or family, CMS’s  tools now allow the consumer to better make a choice based on quality of care.  Those facilities that align their business practices on quality measures and develop a general culture based on clinical outcomes will be better placed in the marketplace to attract new residents and referrals.

For more information on CMS 5 star point system go to http://www.medicare.gov/NHcompare.

Luis Montes, DPT, MBA