NYT says nursing homes use Five Star ratings to 'game' the system

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Knowing residents' interests and capabilities is an important component of dementia care.
Knowing residents' interests and capabilities is an important component of dementia care.

Nursing homes are using self-reported data to pump up their ratings in the Center for Medicare & Medicaid Services' Nursing Home Compare system, the New York Times reported Monday in a front-page article.

The newspaper noted that while annual health inspections are performed by independent reviewers, other factors that build the ratings — such as measures of staff levels and quality statistics — are reported by the operators themselves. The newspaper's analysis reported that while more than 50 nursing homes are on the Special Focus Facilities' federal watch list, close to two-thirds have four- or five-star ratings on staff and quality.

Comparatively, almost all the homes on the watch list received just one or two stars under health inspections. (CMS recently changed its SFF process.)

One way a nursing home can increase its staff rating is by ramping up employee levels before a known inspection. That is when it will fill out its annual staffing level form. Providers often decrease employee levels afterward, the paper noted.

While the investigative piece focused on California, it quotes nationally known industry experts that include American Health Care Association/National Center for Assisted Living's David Gifford, M.D.; Center for Medicare Advocacy's Toby S. Edelman; and Patrick Conway, M.D., the chief medical officer at the Centers for Medicare & Medicaid Services.

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