Medicare Changes 5 Star Nursing Home Ratings

Ava Lawson | October 13th, 2014

Elderly-Family-Member-Spending-Christmas-Alone-300x300Beginning January 2015, a number of changes will be made to Medicare’s rating system for U.S. nursing homes – once considered the gold standard for assessing a facility’s staffing and overall quality. According to the administrator of the Centers for Medicare and Medicaid Services – Marilyn Tavenner – the goal is for “higher-quality reporting” that may lead to better outcomes for patients.

The 5-star rating system evaluates some 15,000 nursing homes on the Medicare government website, but has come under fire for its reliance on self-reported and largely unverified data that ultimately places substandard facilities in four and five star categories.

Medicare rating system relied on self-reports

As reported by the New York Times last August, the nursing home ranking system depended so heavily on unconfirmed data that even facilities with a documented history of violations and staffing problems were earning four and five star ratings. Since the Medicare rating system was initiated in 2009, the number of homes boasting above-average ratings has skyrocketed, which many argue has placed a number of seniors at increased risk for subpar care and/or nursing home abuse. 

Beginning this coming January, nursing homes must start using an electronic system every quarter to report on staffing, which can be verified by comparing to payroll accounts. In addition, a nationwide auditing program will also be initiated, in an effort to confirm whether the quality measures rating is indeed accurate. Another factor considered in the ratings is how many residents are currently being given antipsychotic drugs, some of which have been tied to cardiac arrest and premature death in elderly patients suffering dementia.

“…Yet this push for greater accuracy should help reassure patients and families those improvements are both real and making a difference in improving lives,” commented Greg Crist, a spokesman for the American Health Care Association.

Improving Medicare Post-Acute Care Transformation Act

President Obama recently signed the Improving Medicare Post-Acute Care Transformation Act into law, which earmarks $11 million for the creation of an electronic collection system and will also mandate more regular inspections of hospice facilities. Government officials claim the revised system for collecting nursing home staffing information will do more than verify the accuracy of staffing levels.

With more detailed data available, consumers who are browsing nursing homes for a loved one will be able to review staff turnover rates, which may further highlight the quality of a facility. The new data will take some time to process, however, and will not be reflected in the Medicare ratings until 2016.

“If we are able to get better information on staffing levels, the higher the quality is going to be in the long run,” says Brian Lee, executive director for a nursing home watchdog group.

New York nursing home abuse lawyers

Medicare’s skewed star rating for nursing homes in the New York area has been a growing source of concern for many families, who discovered much too late that their relative or loved one was not receiving the level of care they deserved.

Experienced in elder neglect and nursing home abuse litigation, The Sanders Firm medical malpractice lawyers are here for you during your time of need. If you suspect a loved one has suffered substandard care or outright abusive treatment in nursing home center or acute treatment facility, the law is on your side.

Boasting nearly five decades of service to Bronx, Queens, Brooklyn and Manhattan and Long Island residents, our legal team has recovered millions of dollars in verdicts and settlements on behalf of our clients.

To learn more about filing a NY nursing home injury lawsuit, we invite you to contact us for a no charge consultation today. Call 1-800-FAIR-PLAY.