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• Filed under: Ask Dr. Hospitalist, Practice Management, Columns

• Keywords: patient care, quality data, recruitment

Your hospital medicine questions answered

From: The Hospitalist, March 2009

The Value of Medicare’s Nursing Home Ratings

Is it true that the government has gone public with ratings of nursing homes? If so, where can I find this information? Is this information useful?

H. Sawyer, Richmond, Va.

Dr. Hospitalist responds: Many healthcare providers are familiar with Medicare’s goal to improve the quality of inpatient care. Medicare reports this data at www.hospitalcompare.hhs.gov. The program has its critics, many of whom question whether checking off a list really represents an improved quality of care.

Analogous to its Web site with information about hospital care, Medicare recently unveiled a site with information about the quality of care that our nation’s nursing homes are delivering to Medicare beneficiaries. You can find this information at www.medicare.gov/nhcompare. Medi-care ranks nursing homes on a system that awards ratings from one to five stars, with five stars being the best. Medicare explains it created this rating system to “help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions.” Medicare utilized information from three sources of data to create this overall rating:

• Staffing;
• Quality measures; and
• Health inspections.

The site provides an individual rating for each piece of data and combines the info to determine a composite rating.

Pros and Cons

Medicare acknowledges the rating system has strengths and weaknesses. The staffing information is adjusted for acuity of illness in a given facility’s resident population. That said, the data is self-reported and gathered annually, so it reflects data from just two weeks out of the year. Medicare notes each facility is judged on 10 quality measures, but again, the data is self-reported, is not adjusted for severity, and represents just a few of the many aspects of care that may be important to residents and their families.

Medicare also notes the health inspections are comprehensive and require onsite visits by trained inspectors. Comparisons are best made between facilities in the same state.

Nursing Home Checklist

Aside from facility ratings, Medicare also provides the public with a “nursing home checklist” and encourages the public to take a printed copy of the checklist, along with other information provided on its Web site, when they visit a nursing home. Medicare encourages the public to “talk with the nursing home staff about the information.”

I found no surprising information on this checklist. It encourages the public to think about basic information, such as:

• Is the home Medicare- and Medicaid-certified?
• Is the facility close to family and friends, clean, free from unpleasant odors, and comfortable for its residents?
• Is there a physician present every day and available when necessary?
• Are licensed nurses available 24 hours a day; is an RN available eight hours per day, seven days per week.

The site says individuals should think about resident rooms and the areas outside the resident rooms. It also encourages the public to think about the food and activities available to residents.

Much like the program for evaluating hospital care, I believe Medicare has taken a reasonable first step in providing information to the public to evaluate the care being provided in our nation’s nursing homes. But you will not find information regarding nursing homes that do not accept Medicare. And this information is only about nursing homes, and does not include other types of residential facilities. TH