Study: Some nursing homes inflate self-reporting to boost CMS star rating

Brian Zimmerman - Print  | 

While providers, patients and payers widely use CMS' Nursing Home Compare site to assess care quality at nursing homes, a major component of the five-star rating system is susceptible to inflation, according to a study published in the journal Productions and Operations Management.

CMS star ratings are comprised of three measures: self-reported staffing, self-reported quality measures and an objective score from an on-site inspection. To assess the accuracy of the composite score, researchers compared CMS star rating data from 2009 through 2013 with corresponding financial data and patient complaints issued to the California Department of Public Health for 1,219 in-state nursing homes.

Here are four study findings.

1. Nursing homes with more to gain financially from higher star ratings were more apt to achieve better overall ratings through improvements in self-reported data.

2. Researchers detected little correlation between self-reported measures and on-site inspection results.

3. Nursing home resident complaints were comparable between facilities with the same on-site inspection scores, but varied significantly between facilities with the same overall star rating. Researchers said this finding was indicative of inflation regarding self-reported measures.

4. The team determined at least 6 percent of the nursing homes inflated their self-reported measures for both staffing levels and information on patient health.

"We were able to empirically demonstrate that inflation does exist in the current system," said Xu Han, PhD, an assistant professor in the college of business at Florida Atlantic University in Boca Raton. "So many nursing homes have a five-star rating; they look like they're luxury hotels, but it's difficult to see through that and determine what kind of service they're actually providing. In reality, many of them are not really providing five-star services … We need an effective audit system and to conduct more research on how we can use technology to improve nursing home operations and the rating system."

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