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Medicare System for Rating Nursing Homes to Undergo Significant Changes

Oct 10, 2014

Due to a number of shortcomings, the government is changing its five-star rating system for nursing homes, officials said Monday. The New York Times reports that the current system has been criticized because ratings use self-reported, unverified data. In fact, the old rating system depends so heavily on unverified and incomplete information, that even homes with a documented history of problems were able to get top ratings, NYT reported in August.

In September, the Improving Medicare Post-Acute Care Transformation Act (IMPACT) bill was passed. President Obama signed the bill into law on Monday, funding $11 million to setting up an electronic collection system.

“We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries,” said Marilyn Tavenner, the administrator of the Centers for Medicare and Medicaid Services, which oversees the rating system to NYT.

The US has more than 15,000 nursing homes evaluated by the old rating system, which came into place five years ago. Although it is considered the gold standard, there are a number of glaring flaws. One of the key problems is that nursing homes themselves report on staffing levels and quality statistics, two major criteria used in the rating. To make matters worse, these reports are not usually audited by the federal government.

In January, several changes will be made to address these problems, officials said on Monday. The new system requires nursing homes to report their staffing levels on a quarterly basis; this information will be reported electronically and verified using payroll data. The government will also launch a nationwide auditing program to make sure the quality measures rating, which is based on information collected about each patient, is correct.

Brian Lee is executive director of Families for Better Care, a nursing home watchdog group. “Nursing home quality hinges upon high staffing levels,” Lee said to NYT. “if we are able to get better information on staffing levels, the higher the quality is going to be in the long run.”

Under the new system, hospices will be inspected a minimum of once every three years. There was no requirement prior to this, as many facilities went uninspected for years.

Antipsychotic drugs will also be weighed in a facility’s rating. Although this percentage is already required, it has not had an influence on a home’s rating until now. Oftentimes, nursing home residents with dementia are given these medications unnecessarily as a form of sedation, NYT reports.

Eventually, consumers will be able to look at statistics such as staff turnover, federal officials said; this is a vital measure of quality. Data will be electronically reported next year, but will not be shown in the ratings until 2016.

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