{"id":144,"date":"2021-03-30T17:58:37","date_gmt":"2021-03-30T22:58:37","guid":{"rendered":"https:\/\/www.nursinghomedatabase.com\/blog\/?p=144"},"modified":"2021-03-31T17:18:05","modified_gmt":"2021-03-31T22:18:05","slug":"the-fault-in-cms-stars","status":"publish","type":"post","link":"https:\/\/www.nursinghomedatabase.com\/blog\/the-fault-in-cms-stars\/","title":{"rendered":"The Fault in CMS&#8217; Stars"},"content":{"rendered":"\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/www.cms.gov\/\" target=\"_blank\">The Centers for Medicare and Medicaid Services<\/a> (\u201cCMS\u201d) spends considerable time and effort promoting their Five Star Quality Rating System for Nursing Homes (<a rel=\"noreferrer noopener\" href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/cms-five-star-quality-rating-system-nursing-homes\" target=\"_blank\">see here<\/a>).&nbsp; They even provide an extensive analysis of how they arrive at their ratings (<a href=\"https:\/\/www.cms.gov\/Medicare\/Provider-Enrollment-and-Certification\/CertificationandComplianc\/Downloads\/usersguide.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">see here<\/a>).&nbsp; The ratings are based on a complicated scoring system that involves multiple factors including: both state and agency health inspections, staffing levels and quality measures.&nbsp; The stars shine brightly on the individual facility web pages along with all of the private pages covering the facilities.<\/p>\n\n\n\n<p>There\u2019s just one problem with this system.&nbsp; It is not accurate.<\/p>\n\n\n\n<p>All of the ingredients that I mentioned above plus many more are compiled by CMS into a single number which was called a \u201ccycle score\u201d and now is referred to as a \u201crating score\u201d.&nbsp; It\u2019s what happens next that creates the problem.&nbsp; Once they have that number they first group the facilities by state and then by rating score (lowest to highest).&nbsp;&nbsp;<\/p>\n\n\n\n<p>Did you catch that first step?&nbsp; CMS first groups the facilities by state, then ranks them.&nbsp; The top ten percent of the facilities in each state receive five stars while the bottom 20 percent receive one star.&nbsp; And that how a facility earns its stars; it is simply a ranking of the facilities in a particular state by ratings score with the stars indicating what ranking the facility has achieved in the state.<\/p>\n\n\n\n<p>What this means is that it is not accurate to compare a nursing home in one state to a nursing home in another state using CMS\u2019s Five Star Quality Rating System.\u00a0 It is comparing apples to oranges.\u00a0 To further illustrate this oddity, we have put together a presentation of what CMS calls its \u201c<a rel=\"noreferrer noopener\" href=\"https:\/\/www.cms.gov\/Medicare\/Provider-Enrollment-and-Certification\/CertificationandComplianc\/Downloads\/cutpointstable.pdf\" target=\"_blank\">Cut Point Table<\/a>\u201d. \u00a0 This table shows the range of ratings scores that a nursing home needs to qualify for the different star levels in each state.\u00a0 At the opposite ends of the spectrum are New Hampshire and Nevada.\u00a0 New Hampshire which only has 73 facilities is the most difficult state, requiring a ratings score of less than .667 to qualify for a five star rating.\u00a0 Compare that to Nevada which has 62 facilities but only requires a 40 for a five star rating.\u00a0 Worse still having a 39 rating in New Hampshire means that you would only be a one star facility.\u00a0 In New Hampshire a ratings score of 20.667 was the lower limit for two stars.  (Strangely too, the data for this tables comes from a CMS PDF document.  The data is not actually available as structured data but only as an unstructured PDF.)  <a href=\"https:\/\/www.nursinghomedatabase.com\/list\/cutrate\" target=\"_blank\" rel=\"noreferrer noopener\">Here is a page with the latest data<\/a>.<\/p>\n\n\n\n<p>So, a five star nursing home in Nevada could be worse than a one star nursing home in New Hampshire!&nbsp; How does that make sense?<\/p>\n\n\n\n<p>Piling on to this problem is the fact that CMS does not make it easy to find the rating score.&nbsp; It is available in the data that they publish (and so we have it), but they do not provide it on their pages.&nbsp;&nbsp;<\/p>\n\n\n\n<p>So that&#8217;s it.&nbsp; The Five Star Quality Rating System for Nursing Homes is tragically flawed.  You cannot easily compared facilities from one state to another.  There is a better system, but it is not easy to find.<\/p>\n\n\n\n<p>Luckily, we can help.&nbsp; Each of the nursing home pages that we present shows all of the rating scores.&nbsp; The lists that we provide use the score to sort facilities, and we will be adding additional forms and reports as time provides.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Centers for Medicare and Medicaid Services (\u201cCMS\u201d) spends considerable time and effort promoting their Five Star Quality Rating System for Nursing Homes (see here).&nbsp; They even provide an extensive analysis of how they arrive at their ratings (see here).&nbsp; The ratings are based on a complicated scoring system that involves multiple factors including: both [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-144","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>The Fault in CMS&#039; 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