Biden-Harris Administration Takes Additional Steps to Improve Five-Star Quality Rating System For Nursing Homes

On January 18, 2023, President Biden took additional steps in his pursuit to ensure the transparency, safety, quality, and accountability of nursing homes. In collaboration with the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS), the Biden-Harris administration announced that they’ll take new actions to reduce the inappropriate use of antipsychotic medications and ensure improved transparency about nursing home citations to families. 

“President Biden issued a call to action to improve the quality of America’s nursing homes, and HHS is taking action so that seniors, people with disabilities, and others living in nursing homes receive the highest quality care,” said HHS Secretary Xavier Becerra. “No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind.”

In the last month, the CMS has already started conducting targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with schizophrenia diagnoses. Nursing home residents who are mistakenly diagnosed with schizophrenia are at risk of poor care and are prescribed inappropriate antipsychotic medications. 

Since antipsychotic medications have potential adverse side effects including death. This action drove the Bidden-Harris Administration’s goal of reinforcing safeguards against unnecessary medications and nursing home treatment procedures that were outlined in President Biden’s State of the Union Action Plan for Protecting Scenarios by Improving Safety and Quality of Care in the Nation’s Nursing Homes. 

“We have made significant progress in decreasing the inappropriate use of antipsychotic medications in nursing homes, but more needs to be done,” said CMS Administrator Chiquita Brooks-LaSure. “People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications.”

This action further extends the Administration’s objective to improve the accuracy of the quality information that is publicly reported and the nursing home Five-Star Rating System. The use of antipsychotic medications among nursing home residents indicates the quality of nursing homes and it is used in a nursing home’s Five-Star rating. 

However, it excludes residents with schizophrenia. If an audit highlights that a facility has a pattern of inaccurately coding residents as having schizophrenia, the facility’s Five-Star Quality Measure Rating on the Care Compare site will be negatively impacted. 

If an audit reveals incorrect coding then CMS will downgrade the facility’s Quality Measure ratings to one star. Which would impact the Overall Star Rating as well. CMS will be responsible to monitor each facility’s data to determine whether they have addressed the identified issues. Then CMS will decide whether to downgrade a facility’s Quality Measure or revert their decision. 

Moreover, CMS decides to take more actions to increase the transparency of nursing home information by publicly displaying survey citations that facilities are disputing. Currently, when a facility conflicts with a survey deduction then the deficiency indicated in the survey is not posted to Care Compare until the dispute process is completed. Usually, this process takes almost 60 days or even longer than that. 

While the number of actual deficiencies under dispute is relatively negligible, they can comprise severe instances of non-compliance such as Immediate Jeopardy (IJ) citations. This level of citation occurs when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment or even death. 

If this information is disclosed to the customer while it is under dispute can help the customers to make well-informed decisions when it comes to evaluating a facility. This information will begin appearing on Care Compare on January 25, 2023. Even if the citation will be publicly displayed, it will not be included in the Five-Star Quality Rating calculation until the dispute is complete. 

Under this act, CMS has taken several actions in its years of pursuit to improve public reporting and the Five-Star Quality Rating System. These actions include; 

• The Care Compare website and Five-Star Rating System will include the results of focused control surveys. 
• Increasing the Quality Measure rating thresholds to incentivize improved quality
• Also to add measures of staff turnover to inform customers about the stability of a nursing home’s staff (which is related to the quality of care provided by nursing home facilities.)

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