On Friday, February 20, 2014, the Centers for Medicare & Medicaid Services (“CMS”) unveiled its adjustments to Nursing Home Compare, a website many view as the premier tool for evaluating the nation’s nursing homes. CMS hopes the changes will cause nursing homes to make quality improvements, while critics warn that that the information is still unreliable and could confuse consumers who witness a sudden downward change in a facility’s rating. Nearly a third of the nation’s nursing homes experienced lower star ratings as a result of the changes. CMS stated that 1.4 million viewers access the website annually, with 85 percent of users reporting that they found the information they sought regarding nursing homes.

The website, which ranks more than 15,000 nursing homes on a one- to five-star scale, bases its data on three major criteria: Onsite Health Inspections, Quality Measures and Staffing Levels. The Quality Measures curve, which incorporates metrics such as the prevalence of pressure ulcers, the use of restraints and the extent of injurious falls, was a focus of the recent changes and adjustments to this category caused the most significant hit in ratings. Prior to the changes, 80 percent of nursing homes received a four- or five-star rating on their quality measures score, as compared to nearly half receiving such ratings after the changes.

Consistent with CMS’s ongoing effort to reduce the use of antipsychotics in nursing home residents, two additional measures now target the percentage of residents being given antipsychotic drugs. While nursing homes were previously required to report this statistic, the information is now factored into the 5-Star calculations.

In an apparent response to criticisms that the ratings rely on self-reported, unverified information, the changes also include a requirement that nursing homes begin reporting their staffing levels by using a quarterly electronic reporting system that is verifiable from payroll data. CMS hopes this new system will better account for staff turnover, retention, and levels of different types of staffing. In general, nursing homes can expect to see a ramp up in audits completed at the state level that are designed to scrutinize the quality of self-reported data. The incorporation of additional quality measures, such as data focused on hospital re-admissions for nursing home residents who have had off-site medical treatment, is also expected for 2016.

A Users’ Guide detailing the methodology used for constructing the ratings has been updated and is now available on CMS’s website. Understanding the scoring may enable nursing homes to identify the key areas to focus on in order to boost or maintain ratings.