Billing, Clinical, Five-star quality rating system, News, Skilled Nursing Facility

GAO will investigate the federal government’s five-star rating system

The GAO will launch an investigation into the federal government’s five-star rating system in response to a letter written by U.S. Senator Bob Casey (D-PA), highlighting county by county data. In addition to the senator’s concern, recent news reports have raised questions about the integrity of the federal government’s ‘Five-Star’ rating system that millions of families rely on when selecting a nursing home for their loved one. Casey released a new letter to Gene Dodaro, Comptroller General of the United States, requesting that the Government Accountability Office (GAO) conduct an assessment of the general accuracy and reliability of the Five-Star Quality Rating System for nursing homes and its usefulness as a consumer tool.

The Nursing Home Compare tool is a public website consumers can use to search for and compare nursing homes. The Nursing Home Compare site features the Five-Star Rating System that rates nursing homes on a scale of one to five in three major performance areas – health inspections, staffing and quality measures – as well as one overall rating. The rating system, along with a federal watch list of the lowest performing providers (Special Focus Facilities), is important to nursing homes, not only because consumers use the ratings to evaluate nursing home options, but also because doctors often base their referral decisions on the ratings and insurers do them same when designing their networks.

Specific items that were requested for review include:

  • The steps taken by CMS to ensure that data is timely and reliable, and whether the practices are consistent across CMS regions
  • If there are meaningful distinctions in the different star levels of the rating system
  • How substantiated complaints are aligned with the rankings based on quantity and type
  • The strengths/weaknesses of the system as perceived by stakeholders, including ombudsmen, SAs and others
  • The types of residents/families that are using Nursing Home Compare and how the information could potentially be improved to provide them with additional knowledge and help

Senators ask GAO to review Five Star Rating System for accuracy and to examine the specific items mentioned above.