CMS Five-Star Rating System Five Year Report Available

A report of the Five-Star Rating System , Nursing Home Compare Five-Star Quality Rating System: Year Five Report [Public Version],  was issued on June 16, 2014 summarizing the quality of nearly 16,000 nursing home nationwide since the rating system began in 2008. The report presents a brief overview on the construction of the Five-Star Ratings presented on Nursing Home Compare as well as corresponding descriptive information on the rating and their components.  The Rating System has brought increased attention to the data that are publicly reported on the Nursing Home Compare website.  The study, completed by Abt Associates Inc. for CMS, offers conclusions based on an analysis of data of the three domains of nursing home quality:  health inspections results, staffing, and quality measures (QMs).  Because of the design of the Five-Star Rating System, there is essentially no change in the distribution of Health Inspection ratings.  (By design, the distribution of Health Inspection Star ratings is fixed within each state so that 10 percent of nursing centers receive 5 stars, 20 percent receive 1 star, and 70 percent receive 2, 3, or 4 stars.)  Over the five years from 2009 through December 2013, the proportion of nursing homes receiving a one-star Quality Measure (QM) rating decreased from 20.0 percent to 3.2 percent.  The proportion receiving a four-or five-star rating increased from 34.1 percent to 71 percent. There have been large improvements in the reported QMs since July 2012 when the QM rating was substantially reviewed to incorporate the new MDS 3.0 QMs.  CMS is analyzing this in greater detail.  From January 2009 to December 2013, the proportion of nursing homes with a one-star Staffing rating decreased from 22.9 percent to 12.1 percent.  Although there was a modest increase in the proportion of nursing homes with a Five-Star Staffing Rating (7.2 percent to 10.5 percent), the proportion with a four-star Staffing Rating increased from 30.6 percent to 42.5 percent.
 
There were improvements in the Overall ratings during the five years examined.  To illustrate, in January 2009, 22.7 percent of nursing homes had a one-star rating while 35.2 percent had a four or five-star rating.  By December 2013, the proportion with a one-star rating had declined to 10.5 percent while just over half (50.5 percent) had a rating of four or five stars.  The report further acknowledges it is not possible to attribute the changes in star ratings exclusively to the introduction of the Five Star Rating System.   However, using the current rating algorithm, Abt Associates did analyze health inspection, quality measure and staffing data from the 11 months just prior to the public reporting of the measures and determined that more recent changes may be at least partly attributable to the introduction of the Five Star Rating System.  The entire report including data on each state is available for review here