US News Focuses on Resident Complaints, Staffing in New Set of Nursing Home Ratings

U.S. News & World Report on Tuesday released its 2019-2020 Best Nursing Homes ratings, which the publication has pitched as a more consumer-friendly alternative to the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare website.

Analysts from the national news outlet have moved away from CMS’s five-star ratings to rely on their own research methodologies, with a specific focus on quality of care and staffing consistency.

Zach Adams, senior health data analyst at U.S. News & World Report, said that the company is no longer using the CMS Nursing Home Compare website for domain star ratings.

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“Before last year, we offered an overall rating based on CMS star ratings. I can’t speak to CMS’s methodology, but we are aimed at consumers with the goal of helping patients, residents, and families with web design to ensure it’s accessible for everyone,” Adams said.

The government’s flagship Nursing Home Compare website offers skilled nursing residents and their families data pertaining to a facility’s quality, health inspections, and some staffing categories — a rating system first introduced by CMS in 2008. The facility receives one out of five stars for three domains, which are then averaged into an overall star rating.

Controversies erupted around CMS’s star ratings earlier this year, when the New York Times revealed that some operators inflated ratings while lenders, operators, and some clinicians lament that the system is too regulatory and not focused enough on patient satisfaction.

In response, the government has rolled out a host of changes to the five-star rating program, including stricter standards for earning five-star staffing marks and continuously updated thresholds that encourage operators to keep working towards improvement. CMS also began offering distinct ratings for short- and long-term care quality.

Under U.S. News & World Report’s system, a building’s care quality is classified as high performing, average, or below average — based on metrics such as patients being able to return home, emergency room visits, and fall prevention. This year, a greater focus on patient care involved categories such as the use of antipsychotic drugs, rates of substantiated complaints, patient-centered rehabilitation therapy, consistent nurse staffing, and physical therapist staffing.

The inclusion of those more subjective metrics — such as resident complaints — has long been a goal of providers and policymakers. The American Health Care Association, for instance, has long lobbied CMS to employ a standardized metric of patient satisfaction, though the federal government has indicated that implementing subjective evaluations could be difficult for health care properties.

“When we decide what restaurant we’re going to go to, we don’t go to the inspection report from the local county,” AHCA president and CEO Mark Parkinson told SNN earlier this month. “We go to TripAdvisor and see what the hell everybody said about it, or we go to OpenTable and see what the rating is.”

Mirroring CMS’s decision to separate ratings into two separate categories, U.S. News & World Report this year began presenting distinct results for each building’s long-term and short-term care performance; the publication last year only broke out short-term rehab stays.

“If you just look at a staffing average per year, it can hide bumps along the way, and that form of reporting smooths over problems if a nursing home has many days where there are less than eight hours of registered nurse staffing — especially in the long-term care category where staffing is needed around the clock,” Adams said.

The U.S. News & World Report findings showed that among both short-term and long-term stays, about “45% of nursing homes met regular nurse staffing standards 100% of the time” on a measurement including every day of the year, Adams said.

While the team concluded that most nursing homes are meeting the standards almost every day, Adams said it’s “a little surprising” that more than half of the homes experienced one day in the last year where they didn’t meet the federal requirements.

U.S. News analysts also tracked the conversion rate from short-term to long-term care as part of the ratings.

“If patients can leave short-term care and return home instead of going to long-term are, it’s a good outcome,” Adams said. “The goal for short-term care is to ensure the person leaves the facility to allow as much possible independence.”

For clarification, these analysts didn’t look at how individual homes can improve ratings, but instead focused on the patient’s perspective — including better and consistent staffing driving the quality of care.

According to the report, “2,969 nursing homes earned the ‘high-performing’ mark in at least one of the two ratings.” Only 420 nursing homes got that top rating in both.

Washington, D.C., Hawaii, and Alaska have the highest proportion of so-called “Best Nursing Homes,” with at least half of all Medicare or Medicaid certified properties in these states receiving a high-performing designation in either short-term rehab or long-term care, or both categories.

For the category of short-term rehabilitation, 2,250 nursing homes were high-performing in short-term care, with 8,878 properties earning an average rating for short-term care. Below average in the short-term care category were 2,555 nursing homes.

For the long-term category, only 1,139 nursing homes were high performing with 11,098 average performing homes. In the below average category, 1,448 nursing homes were rated as low ranking for long-term care.

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