Medicare Star Rating Overlooks Evidence of Nursing Home Abuse

State regulators and consumer protections groups who fight to stop nursing home abuse may be having their causes unintentionally undermined by the Centers for Medicare and Medicaid Services (“Medicare”). Medicare, the government agency that certifies nursing homes to receive payment from the federal government, has been taking a page from the playbook of commercial businesses like hotels and restaurants by assigning star ratings – in essence, stamps a seal of quality – on nursing home. The system is intended to help consumers. But according to the New York Times, the process is rife with abuse.

Medicare’s star rating system began five years ago. Only 20% of the 15,000 nursing homes have attained the top rating of five stars. Five-star nursing homes, according the Medicare, are considered to be far above average quality while one-star homes are far below average. Five-star facilities announce their ratings with banners and web site self-congratulations. But the ratings fail to measure key data and, critics believe, mislead consumers who often need to make a quick decision.

Flaws in nursing home rating system

The nursing home ratings consist of one overall rating plus separate ratings for:

• Health Inspections – including information from onsite inspections for the past three years
• Staffing –based on the number of hours of care provided by nursing staff to residents, weighted according to the needs of that particular resident population
• Quality Measures (QMs) –clinical factors measured by nursing homes for all residents, such as bed sores and injuries

According to a New York Times review of the rating system, data is largely self-reported and goes unverified by Medicare. Another major shortcoming is that the data is limited to federal surveys and reports, overlooking state records. Some of the information not included in the star rating includes:

• Fines and other penalties by state enforcement agencies
• Consumer complaints made to state agencies

For example, Rosewood Post-Acute Rehab, in Carmichael, California, has been given the five-star rating. But the rating does not take into account serious state infractions. In 2013, the State of California levied its greatest penalty – a $100,000 fine, against Rosewood for the death of a woman who was overmedicated. The group California Advocates for Nursing Home Reform puts the number of consumer complaints against Rosewood at 164, or twice the state average.

Also not a factor in the rating is lawsuits by patients and their families; in the past few years, Rosewood has been the target of roughly a dozen. Based solely on independently-conducted regulator surveys, the facility earns a 3-star rating. But in factoring the self-reported categories into the equation, it earns an overall 5 stars.

Impact of Medicare star ratings

Medicare states on its nursing home ratings website that the ratings cannot account for all factors that consumers would find important. But while leaving out potentially game-changing factors like state penalties, the ratings have become an important factor for decision-makers. Doctors, nurses, and insurance companies look at the ratings in determining which nursing homes to refer.

The doctor who heads the Medicare nursing home ratings site believes the ratings have motivated nursing homes to improve their quality. But critics believe it misleads the consumers who rely on it by painting a limited picture.