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Nursing home ratings need to be more consumer-friendly, GAO says

A new report from the General Accountability Office finds room for improvement in a government website meant to help consumers choose among nursing homes.

The report stemmed from a request by Pennsylvania Sen. Bob Casey and other lawmakers in the wake of reporting by the New York Times that was critical of the Nursing Home Compare web tool and its Five-Star Rating System.  The Times concluded that the rating system, which includes information on more than 15,000 nursing homes, relied too heavily on self-reported data from the facilities and did not include potentially valuable information about state enforcement actions, allowing poorly performing institutions to receive high ratings.

After that Times report, the Centers for Medicare and Medicaid Services, which operates the rating system, strengthened reporting on nursing home staffing.  It raised the bar on quality measures earlier this year, making it more difficult for a nursing home to achieve a five-star rating.

Casey, Sen. Ron Wyden (D., Ore.), and Rep. Elijah E. Cummings (D., Md.) asked the GAO to evaluate the site in August.  Its 42-page report did not highlight major problems with the accuracy of information on the site, though it did say that the overall ratings most accurately reflected how nursing homes performed during inspections at the extremes: one- and five-star ratings.

GAO offered recommendations that would make the site  more useful for consumers and easier to understand.  The site is used by an average of 914,000 people per year, the report said.

Casey said Monday that he was satisfied with the report "for now" but that more information may be needed.  He said the Nursing Home Compare site has made progress since it was established in 1998 but could do more.  His own test, he said, is how much the site would help people who are trying to find a place for a parent.  "I'm not willing to give out a gold star yet," he said.

Currently, nursing homes are compared only with peers in their own state on a one- to five-star scale.  The GAO recommended that CMS move to a national comparison that would be more helpful to people who live near state borders.  There is no way now, for example, to know whether a five-star facility in Pennsylvania is as good as a five-star nursing home in New Jersey.  The report said that many nursing homes' ratings would change if they had to compete nationally.

CMS rejected this recommendation, saying it's not yet possible to compare nursing home data from different states.  Much of the information used in the rating system comes from state reports and inspections, which vary.

GAO countered that CMS should be working to decrease that variability.   "We maintain that the ability for consumers to compare nursing homes nationally is critical to making nursing home decisions, especially for those consumers who live near state borders or have multistate options, and that our recommendation remains valid," the report said.

CMS awards nursing homes an overall star rating that is based on their performance on three measures: health inspections, staffing, and quality measures.  The report makes it clear that users would be wise to look at the component ratings.  It recommended that CMS add more information about how to navigate the site and use its information.  It also called for CMS to take a more systematic approach to improving the website over time.  And, it called for including consumer satisfaction data in the reports.

Asked about his health priorities under the Trump administration, Casey said he is concerned about the nomination of Rep. Tom Price to be secretary of Health and Human Services  because Price has "led efforts to end the guaranteed benefit of Medicare" and has supported efforts to turn Medicaid into a block-grant program and repeal the Affordable Care Act, or Obamacare.

Medicaid provides health insurance for millions of low-income Americans.  It also pays for nursing home care when residents have exhausted other funds.  The ACA made prescription drugs more affordable for senior citizens. If Trump embraces  House Speaker Paul Ryan's budget, Casey said, it "would be devastating for those who are making decisions about nursing homes and basic health care."