CMS Hits 1,400 Nursing Homes with One-Star Reviews Over Staffing Concerns

Less than a month after a New York Times story revealed concerns about insufficient nursing home staffing levels, the Centers for Medicare & Medicaid Services (CMS) handed out nearly 1,400 one-star reviews.

Last week, when CMS updated its Five-Star Quality Rating System for nursing homes, 1,387 facilities received one-star ratings for staffing coverage, according to a follow-up piece from the Times and Kaiser Health News. Those new negative numbers were either the result of legitimate staffing struggles or a failure to report required payroll data, the Times found.

Previous measures of nursing home staffing levels had relied on self-reported data from skilled nursing operators, which critics said left the program open to manipulation. An academic study into the matter, for instance, found that about 6% of California nursing homes were inflating their quality measures when reporting data to CMS — with the fudging more common in larger, for-profit systems.


The Kaiser/New York Times investigation was based on hard payroll numbers from providers, which CMS began collecting in recent months as part of updated reporting requirements for skilled nursing facilities. In particular, the federal government took aim at facilities that did not have consistent registered nurse (RN) coverage.

“Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter,” CMS warned back in April. “This action will be implemented in July 2018.”

The move ended up lowering overall CMS grades for about half of the penalized homes, according to the Times and Kaiser — but due to increased ratings in other categories, some of the SNFs that received the one-star hit to their staffing metrics actually saw their overall CMS score increase, while 79 retained the highest possible five-star rating.


The team also noted that more reliable data reporting does not accurately portray fluctuations in nurse coverage that some skilled nursing facilities experience. For instance, the average licensed-nurse-to-resident ratio across the country was one per 17 on the best days and one per 33 for the worst.

“It’s a real positive that they actually are taking the payroll-based system seriously, that they’re using it to punish those nursing homes that either aren’t reporting staffing or those that are below the federal limit,” David Grabowski, professor of health care policy at Harvard Medical School, told the Times and Kaiser. “Could they do more? Sure, but I think it’s a really good start.”

Written by Alex Spanko

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