Report leads to question whether CMS has raised the quality bar too high

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More than one-third of the nation's 15,500-plus nursing homes now bear the stigma of poor quality as a result of a tough new star ratings system implemented in February by the Centers for Medicare & Medicaid Services and posted on its Nursing Home Compare website.

In a report published Thursday, the Kaiser Family Foundation declares that 40% or more of nursing homes in 11 states have obtained the lowest ratings of one or two stars. Texas earned the distinction of hosting the highest percentage (51%) of such facilities, followed by Louisiana (49%), Oklahoma, Georgia and West Virginia (each at 46%), and then North Carolina, Tennessee, Kentucky, Ohio, Pennsylvania and New York (all at 40%), according to the report.

On the other hand, nearly half of nursing homes in the country have received the highest ratings of four or five stars.

Ratings drops may have played a part in spurring some new legislative proposals, at least in Texas and Ohio. In the Lone Star State, one such proposal would allow the state to pull the license of any home that gets three Immediate Jeopardy citations within a two-year period, according to the Kaiser report. Another would close a provision allowing homes that fix serious violations to avoid fines.

In Ohio, meanwhile, a proposed budget plan from Gov. John Kasich (R) would hike Medicaid payments by $84 million — if nursing homes meet five new quality measures, according to a report Thursday by the Columbus-Dispatch.

Patient advocates applaud the tougher new system. “Conditions are not changing rapidly enough,” Robyn Grant, director of public policy at the National Consumer Voice for Quality Long-Term Care, told Kaiser Health News. “We hear frequently about poor nursing homes and usually they've been poor for a long, long time. Why are we allowing these providers to continue?”

Skilled nursing operators, however, aren't as charitable in their assessment of the system or the government, which it claims has left many facilities in dire financial condition.

The industry also has noted that the sheer variability in state inspection procedures and rules make cross-comparisons difficult from one region to the next, and has cast a jaundiced eye on the Medicare's shaky reliance on self-reported quality data, the report adds. Moreover, CMS's current system now includes new metrics that reward facilities for lowering use of antipsychotic drugs, even though providers launched their own initiative years ago and have been making substantial progress.

Even in places that didn't make Kaiser Health News' lowest 11 states list, nursing homes are feeling the sting of the tougher standards. In Rockford, IL, for example, more than a third of the community's nursing homes have been branded with one or two stars, according to published reports.