GAO contends CMS website falls short in comparing nursing homes

Auditors say web-based resource, rating system could be improved to assist consumers.

Nursing Home Compare, an online resource provided by the Centers for Medicare and Medicaid Services, enables consumers to research and compare nursing homes using a rating system. However, an audit by the Government Accountability Office has found that while the website is helpful it lacks key information, such as consumer satisfaction scores.

“Nursing home selection can be a stressful and time-sensitive process, so these are important tools that CMS makes available to the public. However, our review found opportunities for improvement in both the website and the ratings,” concludes the report.

In the United States, nearly 16,000 nursing homes participating in the Medicare and Medicaid programs provide care to 1.4 million Americans annually—a number that is expected to grow as baby boomers age. To help the growing population of seniors in need of such services, CMS developed Nursing Home Compare to assist consumers in finding and comparing nursing homes based on a five-star quality system.

Specifically, the GAO discovered several factors inhibiting the ability of the rating system to help users understand nursing home quality and choose between high- and low- performing homes—which is the primary goal that CMS is attempting to achieve.

Also See: Agency offers more info to compare nursing homes

According to auditors, the “ratings were not designed to compare nursing homes nationally, limiting the ability of the rating system to help consumers who live near state borders or have multistate options.” Further, the GAO concluded that the rating system “does not include consumer satisfaction survey information, leaving consumers to make nursing home decisions without this important information.”

To address these and other shortcomings, GAO made four recommendations to CMS on how it can improve the Nursing Home Compare website and make it a better tool for consumers:
  • Establish a systematic process for reviewing potential website improvements that includes and describes steps on how CMS will prioritize the implementation of potential website improvements.
  • Add information to the five-star system that allows consumers to compare nursing homes nationally.

  • Evaluate the feasibility of adding consumer satisfaction information to the five-star system.

  • Develop and test with consumers some introductory explanatory information on the five-star system to be prominently displayed on the homepage. Such information should explain, for example, how the overall rating is calculated, the importance of the component ratings, where to find information on the timeliness of the data, and whether the ratings can be used to compare nursing homes nationally.
A CMS spokesperson declined to comment on the GAO findings and recommendations, and instead referred to the agency’s official written response published in the audit report.

In its written comments, CMS concurred with three of the GAO’s four recommendations but did not agree to add national comparison information to the Nursing Home Compare website. The agency argued that because of state variation in the execution of standard surveys, it is difficult to compare homes nationally on the health inspection component. It also noted that the five-star system is just one of many factors consumers should use when selecting a nursing home.

However, GAO insists that this information is important and should be included.

“We maintain that the ability for consumers to compare nursing homes nationally is critical to making nursing home decisions, especially for those consumers who live near state borders or have multistate options, and that our recommendation remains valid,” states the report.

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