Medicare’s Flawed Ratings for Nursing Homes
by JONATHAN M. METSCH, DR.P.H., LLC
Mar 26, 2015 | 8944 views | 0 0 comments | 1041 1041 recommendations | email to a friend | print
Recently the New York Times http://www.nytimes.com/ * reported: “Medicare has devised a rating system for nursing homes that portrays many of them as much better than they really are. Consumers should be aware that a top five-star rating from Medicare, achieved by a fifth of the more than 15,000 nursing homes nationwide, may mask serious and potentially dangerous deficiencies.

The rating system….. has major flaws, including an overreliance on self-reporting by the nursing homes and failure to include negative information gathered by states. The ratings are based on three criteria. Two of the three — staff levels and quality statistics — are reported by the nursing homes and accepted at face value by Medicare without verification.”

“Only the other criterion — the results of annual health inspections — relies on independent assessments by state inspectors. In addition, the ratings do not take into account other potentially damning information gathered by state Officials at the Centers for Medicare and Medicaid Services, which runs Medicare, say the rating system is supposed to give nursing homes an incentive to improve, but many nursing homes have found ways to game the system. They often know when inspectors will show up and add workers just beforehand and sharply cut staff immediately afterward. And the quality data compiled by the nursing homes themselves — such as how many patients develop bedsores or experience serious falls — is obviously subject to manipulation.

The Affordable Care Act requires Medicare to use payroll data to verify staff levels, but the agency is still working on such a verification system. Medicare should also spot-check the quality statistics while developing a broader auditing program. Improvements are clearly necessary — and soon, because Medicare is about to introduce similar five-star ratings for hospitals, dialysis centers and home-health-care agencies.”

* to read the full NYTs editorial “Medicare’s Flawed Ratings for Nursing Homes”, highlight and click on open hyperlink http://www.nytimes.com/2014/08/26/opinion/medicares-flawed-ratings-for-nursing-homes.html?_r=0

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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration

This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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