The Centers for Medicare and Medicaid Services (CMS) has made several updates to its nursing home care comparison tool to improve accuracy and transparency, said in a note on Wednesday.
Federal agencies will begin posting the listing of “aggregated” performance data for nursing home chains.
Since 2022, CMS has released ownership data linking nursing homes in “chains” and began sharing performance data for these chains in June 2023.
Currently, starting July 30th, CMS will display average ratings directly per chain on nursing home care comparisons. Additional updates include removing outdated testing surveys from health assessments, improving antipsychotic drug use measurements by incorporating claims data, and eliminating Covid-19 vaccination metrics from facility profiles. These changes are intended to help consumers make more informed decisions, the agency said.
“The next step in this effort is that starting July 30, 2025, CMS will publish performance information for each chain (average five-star rating, health tests, staffing, and quality measurement ratings) that directly compare care in nursing homes in a more consumer-friendly format,” the agency said. “This will increase transparency in consumer nursing home ownership and management, allowing them to make more informed decisions about their care.”
Additionally, to better reflect current conditions, CMS removes the old third cycle test from the calculation of facility health inspection ratings.
“To ensure that care in the nursing home compares health, CMS removes the test in the third cycle to more accurately reflect the current performance of the nursing home, meaning the oldest survey from the assessment calculation,” CMS said in the memo.
By incorporating Medicare and Medicaid billing data, agents will further update quality measures for long-term residents receiving antipsychotics, improving accuracy beyond their current reliance on minimum dataset (MDS) data.
And finally, CMS will remove Covid-19 vaccination metrics for residents and staff from the nursing home profile page.
Jodi Eyigor, senior director of nursing home quality and health regulations at Leadingage, told Skilled Nurse News that limiting testing to the latest two rounds could lead to complications due to delays in the investigation.
“As CMS pointed out, outdated investigations (over 45 months) have also stopped working as reliable indicators due to community-related backlogs and labor restrictions. However, relying solely on two investigation cycles, leading to single serious – isolated incidents, to the cosmic rates of erosion and other such as erosion.
This possibility of dramatic variation in assessment highlights ongoing concerns regarding the consistency of the investigation and certification process. The issue has been exacerbated by the new weighting system introduced, with the latest standard surveys and complaints within the past year accounting for 75% of health test ratings, Igor explained.
“We encourage consumers and the public to keep this in mind when evaluating assessments of care comparisons,” she said.
IGor further supports the CMS' decision to add transparency and the publicly available nursing home chain performance data.
“Doing so will help consumers make more informed choices by increasing transparency and making information easier and more accessible,” Igor said.
However, while Leadingage recognizes CMS's ongoing efforts to support transparency in nursing home performance and improve accessibility and accuracy of public reporting through care comparisons and five-star quality rating systems, iGor recommends a “balanced approach” that addresses industry concerns regarding research and rating systems as well as poorly performed facility chains. These concerns include inconsistent enforcement across states and regions, and the “major impact” of individual research on assessments, she said.
Issues of “timely transparency”
CMS directives to post flaws in the investigation, or “timely transparency,” pose challenges and risks, Eyigor said.
“The citations have now been released at the facility as soon as they are received and published before the provider has the opportunity to review their findings or have the opportunity to initiate corrective action,” Igor said.
Leadingage has requested clarification from the CMS to ensure that the new policy is consistent with existing guidelines for public display of citations under conflict.
“We are particularly sure that a new timeline for publishing our findings does not interfere with the existing policy of focusing on publicly available 2567 disputed citations,” she said. “Transparency should not come at a fair price.”
Regarding other CMS directives in the memo, Leadingage supports removing the Covid-19 vaccine metric from the care comparison, claiming it reflects personal choices rather than quality of care.
Eyigor also praised CMS for its focus on antipsychotic use, but said recent changes were lacking, urging them to rule out all clinically appropriate uses beyond the three narrowly defined diagnoses currently designated for CMS.
“An accurate measurement of quality depends on meaningful indicators that reflect the reality of care delivery,” she said.
A “balanced” reporting procedure is required
Holly Harmon, Senior Vice President of Quality, Regulation and Clinical Services at the American Medical Association (AHCA), reflected similar sentiments about CMS in Eyigor, extending equity to all involved parties.
“As long-term and post-acute care changes and adapts over time, it is important that platforms like care comparisons also adjust over time. It is important to fully support the transparency that helps consumers and families make informed decisions about their care and provide more accurate current photos of the quality of each facility,” Harmon said. “At the same time, we need a more efficient and balanced reporting procedure that allows providers to stay focused on what is most important. We provide high quality care to our residents.”
