The Centers for Medicare and Medicaid Services (CMS) is making several updates to the Nursing Home Care Compare tool to improve accuracy and transparency, it stated in a memo Wednesday. 

The federal agency will begin posting “aggregated” performance data for nursing home chains in a clear, consumer-friendly format. 

Since 2022, CMS has released ownership data linking nursing homes by “chains” and, in June 2023, began sharing performance data for these chains.

Now, starting on July 30, CMS will display average ratings for each chain directly on Nursing Home Care Compare. Additional updates include removing outdated inspection surveys from health ratings, refining the antipsychotic use measure by incorporating claims data, and eliminating COVID-19 vaccination metrics from facility profiles. These changes aim to help consumers make more informed decisions, the agency said.

“As the next phase in this effort, starting on July 30, 2025, CMS will publish performance information (average overall 5-star ratings, health inspection, staffing, and quality measure ratings) for each chain directly on Nursing Home Care Compare in a more consumer friendly format,” the agency stated. “This will increase the transparency of nursing homes’ ownership and control for consumers, allowing them to make more informed decisions about their care.”

Also, in order to better reflect current conditions, CMS will remove the older, third-cycle inspections from the calculation of a facility’s health inspection rating.

“To help ensure the Nursing Home Care Compare health inspection rating more accurately reflects current performance in nursing homes, CMS will be removing any inspection in the third cycle, meaning the oldest surveys, from the rating calculation,” CMS stated in the memo.

The agency will additionally update the quality measure for long-stay residents receiving antipsychotic medications by incorporating Medicare and Medicaid claims data, improving accuracy beyond the current reliance on Minimum Data Set (MDS) data.

And finally, CMS will remove COVID-19 vaccination metrics for residents and staff from nursing home profile pages.

Jodi Eyigor, senior director of nursing home quality and health regulation at LeadingAge, told Skilled Nursing News that limiting inspections to the latest two rounds may introduce complications due to survey delays.

“As CMS noted, outdated surveys – some over 45 months old – no longer serve as reliable indicators due to COVID-related backlogs and workforce limitations. However, relying on only two survey cycles introduces increased volatility. A single, serious – but isolated – incident, such as an elopement, can disproportionately affect a facility’s star rating even when overall care remains high,” she said.

This potential for dramatic swings in ratings underscores an ongoing concern about the consistency of the survey and certification process. The issue is further exacerbated by the new weighting system introduced, where the most recent standard survey and complaints within the past year account for 75% of the health inspection rating, Eyigor explained.

“We would urge consumers and the public to keep this in mind when evaluating ratings on Care Compare,” she said.

Eyigor is further supportive of transparency and CMS’ decision to add nursing home chain performance data – currently publicly available – to Care Compare.

“Doing so enhances transparency, and by making the information more easily accessible, helps consumers to make more informed choices,” Eyigor said. 

But while LeadingAge supports transparency in nursing home performance and recognizes the CMS’ continued efforts to improve the accessibility and accuracy of public reporting through Care Compare and the Five Star Quality Rating System, Eyigor is recommending “a balanced approach” that takes into account not only spotlighting consistently underperforming facility chains, but addressing the industry’s concerns about the survey and rating system’s flaws. These concerns include inconsistent enforcement across states and regions, and the “outsized impact” of individual surveys on ratings, she said.

Problem with ‘timely transparency’

The CMS’ directive to immediately post survey deficiencies, or “timely transparency,” poses challenges and risks, Eyigor said. 

“Citations will now be made public at the same time they are received by facilities – before providers have had the opportunity to review findings or have had the opportunity to initiate corrective action,” Eyigor said.

LeadingAge has requested clarification from CMS to make sure that the new policy aligns with existing guidelines for public display of citations under dispute. 

“In particular, we seek confirmation that the new timeline for public release of survey findings will not interfere with the existing policy of noting citations under dispute on publicly available 2567s,” she said. “Transparency should not come at the cost of fairness.”

As for the other CMS directives in the memo, LeadingAge supports removing COVID-19 vaccine metrics from Care Compare, arguing they reflect personal choice, not care quality. 

Eyigor also commended CMS’s focus on antipsychotic use but said recent changes fall short, and urged CMS to exclude all clinically appropriate uses, beyond the three narrowly defined diagnoses currently specified, so as that ensure quality metrics reflect real-world care.

“Accurate measurement of quality depends on meaningful metrics that reflect the realities of care delivery,” she said.

Need ‘balanced’ reporting procedures

Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association (AHCA) echoed similar sentiments to Eyigor on CMS extending fairness to all parties involved.

“As long term and post-acute care changes and adapts over time, it’s important to see platforms like Care Compare adjust over time, too. We remain fully supportive of transparency that helps consumers and families make informed decisions about their care and offers a more accurate, current picture of the quality of each facility,” said Harmon. “At the same time, we need more efficient and balanced reporting procedures that allow providers to remain focused on what matters most: delivering high-quality care to residents.”