Is Simpler Better in Rating a Nursing Home?

For many years, the Centers for Medicare and Medicaid Services has posted data on its Nursing Home Compare site on quality of care, health-inspection results, and staffing, giving families something more to consider when choosing a nursing home than brochures, promises, and impressions from a visit. Working with this complex information can be challenging.

So today, CMS rolled out a revamped approach to make things easier. Like the system CMS uses to rate Medicare health and drug plans, it gives nursing homes from one to five stars in each of three key areas—10 quality measures, such as the percentage of residents with urinary tract infections; performance in the three most recent health inspections; and adequacy of staffing. Each facility also gets from one to five stars overall.

It's easy to understand, as CMS says. A glance is all that's needed for "making meaningful distinctions between high-performing and low-performing nursing homes." More than 15,500 nursing homes got overall ratings in the initial launch. In states with 25 or more nursing homes, Delaware had the highest proportion of five-star homes (30.2 percent) and Louisiana the lowest (2.8 percent). How they broke down:

Simplicity is not always a virtue, however. After eliminating one-star homes from consideration, as most people would do, and focusing on those with high ratings, users could overlook enormous variations in performance within the three key areas. Much of the information fed into Nursing Home Compare, moreover, has been and remains suspect; the stars camouflage the shakiness of the data. Staffing, for example, is self-reported by the homes and provided to CMS once a year; staff turnover can be well above 100 percent a year at many nursing homes.

The data that previously was on the CMS site will remain posted, and CMS doesn't want consumers to use the overall ratings—or the category ratings—to be the only factor in choosing a home. But it's a human tendency to go for the quick and easy conclusion, which is now wrapped up in displays of stars.

I'll report again later today, after a press conference.