Medicare Star Rating System Not An Accurate Measurement of Nursing Home Quality

The Center for Medicare and Medicaid Services (CMS) has offered a Medicare star rating system, in the style of hotel ratings, for nursing homes for the past five years. Only one-fifth of the United States’ 15,000 nursing homes achieve a 5-star rating from Medicare, suggesting that the rating system has exclusive criteria.

However, an article from the New York Times on Monday, August 25th, suggested that the Medicare star rating system for nursing homes is bogus. Although Medicare awards the ratings based on three sets of standards, two of those sets of information are self-reported by the nursing homes, and is not objectively verified by the government. The third metric for the nursing home rating system comes from annual health inspections, which are required for all nursing homes by the federal government.

By allowing nursing homes to self-report data regarding staff levels and quality statistics, without independently verifying the reports, allows nursing homes to “game the system,” according to the Times article. Nursing homes can basically lie about what patients think about the quality of care at the facility.

“This whole program has walked into parts of our industry that we never expected,” said Steven Littlehale, executive vice president and chief clinical officer at PointRight, one of a handful of consulting firms that work with nursing homes to improve their Medicare ratings. High ratings not only inform patients, caregivers, and families about which nursing homes they might choose, but also attract the attention of lenders and investors, who are interested in one of the fastest-growing sectors of the economy.

Worse, the rating system does not include information about state-level enforcement actions such as fines and consumer complaints, including allegations or charges of nursing home abuse. There are 50 nursing homes on the federal watch-list for quality, meaning they not only failed state-level safety standards but are failing looser federal regulations, but nearly two-thirds of those nursing homes hold 4- and 5 Medicare star ratings. One of the highest-rated nursing homes in the country – Rosewood Post-Acute Rehab in Sacramento – was fined the highest penalty possible of $100,000 for the 2006 death of a woman from an overdose of blood thinner.

Interviews with current residents at Rosewood, which markets itself like a luxury hotel, show that overwhelmingly, they do not believe the nursing home deserves its 5-star rating. “If I fell down, they’d pick me up, but that’s about it,” said Michael McFadden, 76, who has lived at Rosewood for several years.

“It looks nice when you walk in,” said Bonnie Nathan, who placed her mother in Rosewood because of the 5-star rating in 2010. However, she believes that nursing home abuse and neglect on the part of staff led to her mother’s death from a respiratory infection and she is now taking the nursing home to court.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” said Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy, a nonprofit organization that helps patients. “It seems implausible.”

The Strom Law Firm Can Help Victims of Nursing Home Abuse

If your loved one has faced nursing home abuse, you do not have to suffer in silence. Contact the attorneys at the Strom Law Firm for a free, confidential consultation. We are here to help. 803.252.4800.