The Government Accountability Office (GAO) has reviewed the Medicare Five-Star Quality Rating System for nursing homes and identified several factors that may prevent consumers from using the website “as an easy way to understand nursing home quality and identify high- and low- performing homes.”  In particular, GAO concluded:

  • The Centers for Medicare & Medicaid Services’ (CMS) formula for determining overall ratings “is not intuitive, which can make interpreting overall ratings difficult for consumers by both complicating the comparison of overall ratings and masking the importance of the component ratings.”
  • A nursing home’s rating “is a point-in-time picture of performance based on a prior snapshot of the home’s performance and may not reflect a nursing home’s current status.”
  • The ratings do not allow consumers to compare the quality of homes across states, limiting their usefulness for consumers who live near state borders or have multistate options.
  • The system does not include consumer satisfaction survey information.

The GAO recommends that CMS add information to the Five-Star System that allows homes to be compared nationally (which the Department of Health and Humans Services (HHS) contends is difficult because of variations in state surveys).  The GAO also recommends that CMS evaluate adding consumer satisfaction information to the Five-Star System and develop introductory explanatory information for the Five-Star System web site; HHS concurred.  Furthermore, the GAO recommends that CMS establish a process to evaluate and prioritize website improvements; HHS agreed to create a more formal process for making such improvements.

The report, “Nursing Homes: Consumers Could Benefit from Improvements to the Nursing Home Compare Website and Five-Star Quality Rating System,” is available on the GAO website.