Oct 8, 2014

In the future, you can put more trust in Medicare nursing home ratings

In my October 2014 ENewsletter (subscribe here) I mentioned the alleged shortcomings of the Medicare 5 star rating system for nursing homes. Its detractors claim that the system, put in place in 2008, relies too heavily on unverified data that nursing homes themselves provide, resulting in sometimes misleading and overly rosy ratings. The two indices that have come under the most intense fire from critics are staffing levels, and quality of care. An overhaul is needed. And it's on its way.

A new law is going into effect that will beef up reporting requirements and increase federal oversight and auditing. Below is a brief overview of the changes you can expect once the so-called Impact Act (Improving Medicare Post-Acute Care Transformation Act) goes into effect:
  • Nursing homes will be required to report staffing levels electronically. Reports will be submitted on a quarterly basis and will be verified against electronic payroll data. Staff turnover will also be part of the reporting requirements and will be weighted into the overall ratings. The new reporting requirements go into effect in 2015, meaning updated ratings will be available starting in 2016.
  • There will be greater oversight and more frequent auditing to ensure that quality-of-care reports are accurate. Quality of care refers to factors such as percentage of falls and bedsores residents experience. In addition, the percentage of residents receiving anti-psychotic drugs will be factored into the ratings.
  • Hospice facilities will be scrutinized more closely and will be audited more frequently. Currently Medicare requires that the states inspect these facilities every six years.
It is hoped that the new reporting system will better serve the public and of course, improve care for nursing home residents. More details on this new program can be found here.

By the way, Medicare is also introducing a five-star rating system into its comparison tool for hospitals, dialysis centers, home health care agencies and physicians. Look for these changes in 2015. More information.

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