Home Health & Hospice Week

Nursing homes are the first providers ranked by the system.

If you're not too worried about your Home Health Compare standing, you soon may change your mind.

The five-star rating system for nursing homes that the Centers for Medicare & Medicaid Services launched last month is likely to soon come to home health agencies and hospices, predicts consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C.

"If the rating system proves both popular and not subject to serious challenge, it seems a move to home health would be inevitable," agrees Bob Ward-well with the Visiting Nurse Associations of America.

As CMS moves toward pay-for-performance reimbursement, a rating system would make even more sense, Laff believes.

How it works now: CMS bases its five-star system for nursing homes on survey results, staffing levels, and quality of care information, the agency says in a release. The agency uses only a subset of the measures included on Nursing Home Compare to make up the quality portion of the rating.

About 12 percent of nursing homes currently earn a five-star rating, while 22 percent have one star, CMS reports. The rankings are updated monthly.

"Our goal in developing this unprecedented quality rating system is to provide families a straightforward assessment of nursing home quality, with meaningful distinctions between high and low performing homes," CMS Acting Administrator Kerry Weems says in the release. "The new information will also help consumers and families identify important questions to ask nursing homes and challenge nursing homes to improve their quality of care."

The system has the support of some members of Congress, too. "With this new rating system, CMS is improving the ability of consumers to readily obtain critical information," Sen. Herb Kohl (D-Wis.) says in the release.

According to a recent survey by the Kaiser Family Foundation, the public pays little attention to currently available comparative data about providers (see Eli's HCW, Vol. XVII, No. 44-45, p. 352). But that's likely to change with an easy-to-understand rating system like the one CMS has adopted, experts predict.

Numerous newspapers across the country have already run stories about the ratings for their local nursing homes. And USA Today hailed the program as a "remarkably consumer-friendly move" that makes comparison shopping for a nursing home much easier than before.

When you add that with the fact that the aging population that soon will be requiring home care services is increasingly computer-friendly, you can expect "a big increase in the numbers accessing quality information on the Web" in the next five years, Laff forecasts.

But the new system isn't beginning without opposition. Nursing homes and their representatives have come out against the ratings. The system oversimplifies quality indicators and assigns low ratings to some providers who provide good care, says the trade group American Health Care Association. Many facilities don't understand how their ratings are calculated, either, they say. Others say the system is just unfair.

Example: In the Hilton Head Island area, the local newspaper pointed out that two nursing homes received five stars, one received four stars, and one received one star, Laff relates. The one-star home was the only one that accepts Medicaid patients.

"There may be some validity to the lack of some type of risk adjustment taking this issue into account," Laff believes. "The funding for Medicaid patients is poor and a percentage of Medicaid patients often are also those without family and other financial support."

HHAs have long argued that risk adjustment for Home Health Compare measures also doesn't adequately take Medicaid and dual eligible patient issues into account.

Nursing homes and HHAs also have a big difference in what standards are available for comparison, points out Wardwell, a former top CMS official. The five-star system for nursing homes uses objective data like staffing levels. All of HHAs' quality data is based on self-reported patient characteristics.

Once new process-based measures take effect on OASIS-C, CMS may have less subjective quality criteria to use, Wardwell suspects.