The New York Times reports today on flaws in the Medicare-developed star system of rating nursing homes. Top-rated nursing homes often turn up with serious problems. How does this happen?
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.
Insiders say the homes have figured out how to game the system. Ratings are going up in the industry. Results:
The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics.
The system seems likely to spread.
Beginning this year, Medicare plans to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.
It puts me in mind of the Arkansas legislature’s push to reduce school assessment to a simple letter grade. Nobody would ever dare suggest a school administrator would game a rating system. Or that a rating might be as much a product of the raw material put into those education factors as of the quality of teachers and programs.