Anyone who has worked in a nursing home knows that a Medicare five-star rating doesn't mean much. Now the news is finally reaching the general public. A recent New York Times revealed that most of the data that makes up a Medicare rating is submitted by the facilities, which can massage the data to put themselves in a positive light. Hopefully, this will lead to reforms in the way nursing homes are rated.
Medicare Star Ratings Allow Nursing Homes to Game the System
By KATIE THOMAS AUG. 24, 2014
CARMICHAEL, Calif.- The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes.
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood's five-star status -the best possible-places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction.
But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.
The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings-the results of annual health inspections-relies on assessments from independent reviewers. The other measures-staff levels and quality statistics-are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.
The ratings also do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities, as well as complaints filed by consumers with state agencies. Last year, the State of California, for example, fined Rosewood $100,000-the highest penalty possible-for causing the 2006 death of a woman who was given an overdose of a powerful blood thinner.