- Nursing Home Compare, the rating system created by Medicare in 2009, was mean to create greater transparency in the industry. But it may be based on incomplete information and because the data used is self-reported, could be allowing nursing homes to work the system to get ratings beyond what they deserve.
- The New York Times investigated Nursing Home Compare and found that many ranked near the top may be using the self-reported data (staff levels and quality statistics) to increase their ranking to five stars, the highest available. Information like lawsuits and state-level complaints and fines are not part of the tabulation.
- Star ratings are important to nursing homes because they are used by doctors to determine where to send a patient post-discharge; by insurers to set up networks; and investors and lenders to determine investment potential—creating an incentive for homes to represent themselves in the best possible light.
Adding to the evidence against rankings based on self-reported data is the percentage of facilities with above-average ratings. When the program began in 2009, 37% of homes receives four- or five-star rankings. By 2013, that proportion had risen to nearly half. Meanwhile, even homes with a history of poor care rank highly on Nursing Home Compare: There are more than 50 facilities on a federal watch list for quality, and almost two-thirds of those have four- or five-star rankings on Nursing Home Compare. Those same facilities do not do well in an independent review setting; In fact, over 95% of the homes on the list have only one or two stars for the health inspection performed by state workers.
Some call Nursing Home Compare a good first step to gauging quality in nursing homes. Others see it as a way to weed out the very worst homes. Regardless, ratings systems are still an imperfect tool for ascertaining quality, and it is becoming clear that the self-reported aspects of the ratings will be scrutinized more closely in the future. The Centers for Medicare and Medicaid Services are looking at ways to do this, including using payroll information to verify staffing levels.