CMS posted a report on June 28, 2013 analyzing the Nursing Home Compare Five-Star Quality Rating System from the years 2009 to 2011 (Three-Year Report).  The report discusses trends in quality ratings for nursing homes and provides corresponding descriptive information on the ratings and their components.  The report, which was prepared by Abt Associates Inc., determines that there is evidence of improvement in nursing home performance since the implementation of the Five-Star Quality Rating System.

In December 2008, CMS added a set of quality ratings to the Nursing Home Compare website for each nursing home that participates in Medicare or Medicaid.  The ratings are in the form of a set of “star” ratings for each nursing home and are based on nursing homes’ performance on health inspection surveys, staffing levels, and a set of quality measures (QMs) derived from the Minimum Data Set (MDS).  The Five-Star Quality Rating System includes ratings for each of these three domains along with an overall rating.

The three-year report includes a detailed description of the Five-Star Quality Rating System methodology.  It also describes trends in quality ratings for the years 2009 to 2011.  The report shows that there have been improvements in the health inspection, quality measure, and staffing domains since the implementation of the Five-Star Quality Rating System.  Specifically, the report finds:

  • Due to the design of the rating system, there has been virtually no change in the distribution of health inspection ratings.  However, an analysis of the average number of deficiencies shows that health inspection scores have generally improved for more recent surveys (except for one-star facilities).
  • The percentage of facilities receiving a one-star quality measure rating decreased from 20 percent to 11 percent during the Five-Star Quality Rating System’s first three years.  The percentage of facilities receiving a four- or five-star quality measure rating increased from 34 percent to 47 percent.
  • From January 2009 to December 2011, the percentage of facilities with a one-star rating for staffing levels decreased from 23 percent to 13 percent.  The percentage of facilities with a five-star staffing rating increased from 7 percent to 9 percent, while the percentage of facilities with a four-star staffing rating increased from 31 percent to 39 percent. 
  • There were improvements in overall quality ratings from 2009 to 2011.  The percentage of facilities with a one-star rating decreased from 23 percent to 16 percent, while the percentage of facilities with a four- or five-star rating increased from 35 percent to 43 percent.

The report notes that changes in quality measures and staffing are based on data that are selfreported by facilities, so it is possible that these changes reflect changes in reporting practices rather than actual improvements in quality.  The full report is available by clicking here.