Lindsay J. Peterson, PhD

Revising the Centers for Medicare & Medicaid Services’ (CMS) rating system may be useful for providing accurate information to the public that reflects consumer opinions on nursing homes, according to new findings.¹

This research was conducted to re-assess the CMS Five-Star Rating System, which is based on regulatory deficiencies given during complaint investigations and on-site recertification surveys.

Nursing home stakeholders had expressed concern over the predictability of the nursing home visits that occurred during the surveys every 9 to 15 months, mentioning that the true quality of nursing homes are not reflected correctly and thus do not help the homes to address conditions properly.

The study was authored by Lindsay J. Peterson, PhD, from the School of Aging Studies at the University of South Florida.

“The Centers for Medicare & Medicaid Services’ Five-Star Quality Rating System combines results from nursing home recertification surveys and complaint investigations into a single indicator for health inspections,” Peterson and colleagues wrote. “This combination may mask complaint investigation results.”

Research and Methods

The investigators involved 15 ,499 nursing homes in the US for the study, using the Nursing Home Compare Five-Star Quality Rating System to determine three 5-star ratings, which involved the following:

• An overall health inspection rating, which combined recertification survey scores and complaint investigation scores
• A rating using only recertification scores
• A rating using only complaint investigation scores

The complaint investigations were particularly useful, given that complaint reports begin with staff, residents, or others in close contact with the homes and they can be given at any point, which may better demonstrate a home’s condition when it is unprepared for scrutiny.

Through the use of these rating systems and the sample population, the investigators calculated the different star ratings for nursing homes during November of 2017.

The investigators used every participating home’s most recent recertification surveys, which had been made from 2016 to 2017. The team also used homes with 36 months of information drawn from the ASPEN Complaints/Incidents Tracking System as well as the Certification and Survey Provider Enhanced Reports.

Study Results

The investigators concluded that of the selected nursing homes, there were 19.8% with 1 health inspection star, there were 23.2% with 2 stars, there were 23.2% with 3, there were 23.2% with 4, and there were 9.8% with 5.

The team also found that the majority of them had maintained their same overall and recertification star ratings, but they also noted that a somewhat large number of these homes (around 25%) had no complaint deficiencies and had high star ratings as a result.

While the results of the recertification surveys were found to be similar to the health inspection star ratings, the homes’ recertification survey scores were distinct from complaint inspection scores.

This indicates that health inspection ratings may not actually demonstrate the truths about consumers’ opinions on services, care, or other elements to the homes.

“Overall, our findings substantially contribute to the research on nursing home complaints by suggesting that nursing home complaints can be a valuable source of information concerning nursing home quality,” they wrote. “At the same time, the results highlight critical questions about the complaints process, particularly concerning the number of nursing homes with no or very few complaints.”

References:

1. Peterson LJ, Bowblis JR. Assessment of Consumer Complaint Investigation Scores, Recertification Survey Scores, and Overall Nursing Home Health Inspection Star Quality Rating. JAMA Netw Open. 2023;6(2):e2253952. doi:10.1001/jamanetworkopen.2022.53952