Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

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In 2008, the Centers for Medicare and Medicaid Services (CMS) launched the Five-Star Quality Rating System on its Nursing Home Compare website to provide summary information to help consumers choose a nursing home in their area. CMS recently modified the methodology of these ratings, began posting more information about nursing home deficiencies from state health inspections, and is planning future steps to increase the star ratings’ reliability, as required by certain provisions in The Affordable Care Act (ACA) and the Improving Medicare Post-Acute Care Transformation Act (IMPACT). This issue brief presents national and state-level analysis of nursing homes quality scores based on these five-star ratings and discusses relevant policy considerations.

Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

The nursing home population includes some of the oldest, frailest, more medically compromised and cognitively impaired people covered by Medicare or Medicaid. Nursing home residents—both short-term and longer term residents—are particularly at risk because they are often unable to care for themselves, and dependent on others to get by on a day-to-day basis. Medicare and Medicaid, which together account for more than half of all nursing home revenue, require facilities to meet minimum federal standards to help safeguard the health and safety of nursing home residents. Further, CMS has developed and improved the Nursing Home Compare website to provide consumers with both detailed and summary information on nursing home quality. Nonetheless, researchers, reporters and advocates have continued to identify serious quality concerns among some of the nation’s nursing homes, including those that relate to inadequate staffing, high rates of preventable conditions, such as pressure ulcers (bedsores), and fire safety hazards. A recent study, for example, found that almost one in five nursing homes had deficiencies that caused harm or immediate jeopardy to residents.

PQA Measures Used By CMS in the Star Ratings & As Display Ratings Program

Understanding the CMS Quality Evaluation System There are multiple components to CMS’ evaluation of medication-related quality across Medicare Parts C and D. CMS creates plan ratings that indicate the quality of Medicare plans on a scale of 1 to 5 stars with 5 stars being the highest rating. The overall star rating is determined through numerous performance measures across several domains of performance. Each measure is awarded a star rating and the individual measure stars are then aggregated at the domain and summary level. Only a small number of plans receive a 5-star summary rating from CMS, with most plans receiving 3 to 4 stars. Medicare Advantage plans that include drug benefits (MA-PDs) are rated on performance measures for Parts C and D. For Part C, a subset of the HEDIS measure set from NCQA is used for evaluation. Medicare Part D stars are applicable to MA-PDs and stand-alone PDPs. The stars are assigned based on performance measures across four domains. The four Part D domains are: 1. Drug Plan Customer Service 2. Member Complaints, Problems Getting Services, and Choosing to Leave the Plan 3. Member Experience with Drug Plan 4. Drug Pricing & Patient Safety There are 15 individual measures of quality in the 2016 Part D ratings based on 2014 prescription drug claims). Medication safety and adherence measures are in the domain of Drug Pricing & Patient Safety. Five PQA measures are included in this domain for the 2016 Star Ratings. These include three of PQA’s medication adherence measures in the following therapeutic categories: HMG-CoA inhibitors (statins), Renin Angiotensin System Antagonists, and Oral Diabetes Medications. Two measures of medications safety or MTM are also included, High risk medications in the elderly and Comprehensive Medication Review (CMR) Completion Rate. The CMR Completion Rate measure is new for 2016. Each measure is assigned a weighting factor. Outcomes and Intermediate outcomes are weighted higher. The PQA measures in the plan ratings and their respective weighting are described on the following page. In addition to the plan ratings, CMS also uses the “Display Measures” to provide further evaluation of Part D plans. The Display Measures are not included in the plan ratings, but are used to facilitate quality improvement by the plans. The Display Measures include three PQA-supported measures of medication safety (drug-drug interactions; excessive doses of oral diabetes medications; Statin Use in Persons with Diabetes). An additional measure, HIV antiretroviral medication adherence, is reported to plans in their Safety Reports. CMS maintains a “Patient Safety website” that provides the benchmarks and scores to the plans across both the Display Measure and Plan Ratings Measures. Who Manages the Star Ratings System? CMS manages the star ratings system and uses contractor support for this effort. For example, CMS contracts with Acumen, LLC for the analyses of Medicare data to generate the rates for the medication measures. PQA maintains the PQA-supported performance measures and updates the technical specifications and drug-code lists for the measures every six months. PQA also shares new measures that are endorsed by PQA with CMS and provides some technical guidance on the use of the measures within the plan ratings. CMS tests updates to the PQA-supported measure specifications and drug-code lists and implements these as they deem appropriate.

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  2. Star Ratings Coming Soon to Compare Sites on
  3. Humana, Cigna hit by lower 2017 Medicare star ratings
  4. 5 Star Medicare Advantage Plan Ratings 2015
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