Medicare Basics: The Five Star Rating System

July 12, 2009

By system

This article, written by Jill Gilbert, originally appeared as ” Five Star is Progress” in McKnight’s Long Term Care News February 2009 edition. The Center for Medicare and Medicaid Services has just recently released a new rating system to grade the 16,000 nursing homes in the United States that participate in Medicare or Medicaid. With the goal of streamlining the data already publicly available, the new system assigns nursing homes one-to-five-star ratings based on quality of care data, staffing information and health inspection surveys. The rating system falls short of its primary objective: helping families understand the qualitative data on facilities. The new rating system doesn’t add any new information, and it doesn’t account for patient or family satisfaction. The point is to help consumers compare nursing homes more easily. CMS advises consumers to use the star ratings to narrow their options, then review the deficiencies and citations in detail.

But the problem with this is that the ratings are sometimes unfair or misleading, essentially excluding some facilities from the consumer search to begin with. It’s an oversimplification of a very complex system that gives consumers only part of the picture. Looking ahead. Since its implementation, the rating system has been under fire from the nursing home industry, which is very much concerned about inaccurate representation of facilities, as well as consumer groups, who want understandable, reliable information which they don’t find in the current inspection data. But Rome wasn’t built in a day. The new rating system may not be perfect, but it is progress. We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.

We need to remember why CMS created the rating system in the first place: to make the inspection data less confusing and to help consumers make informed choices. Moving forward with innovative solutions is key in any industry, and essential for the skilled nursing industry. Voicing our concerns as providers and consumers will help CMS work out the kinks in the new system.

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