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Garbage in Ratings Out Commentary 

Garbage in Ratings Out

As CMS continues to evolve quality reporting requirements for hospitals and nursing homes, the law of unintended consequences can come into play as administrators struggle to raise their ratings. In a recent article on Bloomberg News titled New CMS Nursing Home Ratings Don’t Solve Accuracy IssuesSenator Michael Williamson reports the following:

“Increasing the number of measures on which nursing homes must report offers seniors and people with disabilities, along with their families, more information when picking a nursing home, Sen. Bob Casey (D-Pa.) said. However, these changes don’t “impact the accuracy and reliability of the measures reported,” Casey said, adding that he and Sen. Ron Wyden (D-Ore.) in 2015 asked the Government Accountability Office to examine the nursing home five-star rating system and help determine its accuracy (167 HCDR, 8/28/15).”

In addition to concerns about the accuracy of CMS ratings, health careproviders are sometimes struggling to make sense of the CMS quality reporting system. With the addition of new requirements, many nursing homes would see their ratings drop even though there has been no change in their reporting, as reported below:

“The February 2015 changes “caused an estimated 4,777 of 15,500 centers nationwide to lose one or more stars in their individual quality rankings even though nothing about the quality of care those centers offered changed,” Greg Crist, senior vice president of public affairs at the AHCA,told Bloomberg BNA in August 2015.”

While the quality of care that is delivered in a healthcare setting will directly affect the ratings, other outside factors may prove more important. Hospitals and nursing homes in areas with patients with more lifestyle issues will likely see lower ratings even though the quality of care they are delivering is equal to those in more affluent areas. Smaller institutions may also be hit by ‘black swan’ events that don’t average out in their ratings.

The quality of data captured can also have a big effect on ratings causing hospitals and nursing homes to spend a lot more to make sure they are capturing information in a way that demonstrates quality outcomes. While this can be a positive influence, it can also detract from care delivery if documentation takes precedence over care.

As regulations for quality reporting change, training and system changes add to the expenses of hospitals and nursing homes at a time when increasing financial pressure is on them due to lower reimbursements. EHR software vendors also have to stay current with the changing landscape and will pass the cost on to hospitals.

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