[Reblog] A 5-star rating system for nursing homes and the unintended consequences on health care disparities

From the 8 May 2015 post at Science Health

Information about the quality and performance of health care facilities can be confusing to consumers. Dozens of government organizations, trade groups and websites rate doctors, hospitals and long-term care facilities on all kinds of scales, from patient satisfaction to medical outcomes.

In 2008, the Centers for Medicare and Medicaid Services (CMS) attempted to simplify some of this data by creating a five-star rating system for nursing homes. The idea was that public reporting would drive improvement in care, helping nursing home residents and their families choose higher quality facilities, in turn encouraging nursing homes to improve quality to retain residents.

This data can be of limited use, however, for people whose decisions are constrained by insurance networks, cost and geography. People who are enrolled in both Medicare and Medicaid, often called “dual eligibles,” are particularly limited in their choices for long-term care. They are much more likely to have lower incomes, disabilities or cognitive impairment, and to receive low-quality health care in poor neighborhoods than other Medicare beneficiaries.

A new study in the May issue of Health Affairs by public health researchers from the University of Chicago, Harvard, and Penn confirms that despite best intentions, the new rating system exacerbated health disparities between this dual eligible group and non-dual eligible nursing home residents, i.e. those with better financial support. By 2010, two years after the system began, both groups lived in higher quality nursing homes overall, but non-dual eligible residents were more likely to actively choose a higher-rated nursing home. The gap between the two groups also increased: dual eligibles were still more likely to live in a one-star home, and less likely than non-dual eligibles to live in a top-rated home.

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Feds release nursing home inspections, free of censor’s marks

Public Health--Research & Library News

From ProPublica:

In response to a Freedom of Information Act request by ProPublica, the government has released unredacted write-ups of problems found during nursing home inspections around the country. We’re making them available today for anyone who wants to download the complete versions.

For several months now, ProPublica has made redacted versions of this same information available in an easily searchable format in our Nursing Home Inspect [1]tool. These versions, which reside on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Compare [2], sometimes blank out patients’ ages, medical conditions, dates and prescribed medications.

The agency has said the redactions are intended to balance patient privacy concerns with the need to inform consumers about the quality of care. ProPublica requested the unredacted reports because they are public records and because the added information can make them more useful.

In response to a Freedom of Information Act request…

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Why Do More People Die During Economic Expansions?

St Annes Nursing Home (Photo credit: Wikipedia)

From the April 2012 brief at the Center for Retirement Research at Boston College

The brief’s key findings are:

• When economic times are good, deaths in the United States increase.

• Previous research suggests that a likely culprit is poorer health habits tied to greater job demands.

• However, the increase in mortality is largely driven by deaths among elderly women in nursing homes.

• These nursing home deaths may reflect increased shortages of caregivers during economic expansions.

Related articles

• Death Rates Higher In Nursing Homes During Good Economy (nursingassistants.net)

CMS Launches Tools and Initiatives to Help Improve American Health Care Quality

The Centers for Medicare & Medicaid Services (CMS) announced a new tool for patients and caregivers, and other enhanced initiatives, to empower consumers to make informed choices about their health care, and to help improve the quality of care in America’s hospitals, nursing homes, physician offices, and other health care settings.

From the  5 August 2011 press release

“These tools are new ways CMS is making sure consumers have information about health care quality and important information they need to make the best decisions about where to receive high-quality care,” said Dr. Don Berwick, the CMS Administrator.  “These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system.”

The steps announced today include:

·       A Quality Care Finder to provide consumers with one online destination to access all of Medicare’s Compare tools — comparison information on hospitals, nursing homes and plans: www.Medicare.gov/QualityCareFinder.

·       An updated Hospital Compare website, which now includes data about how well hospitals protect outpatients from surgical infections and whether hospitals care for outpatients who are treated for  suspected heart attacks with proven therapies that reduce death: www.hospitalcompare.hhs.gov

Read the entire press release 

Related articles

• CMS Updates Medicare.gov Portal With Added Searches and Comparison Information (ducknetweb.blogspot.com)
• U.S. health care system fails to deliver – Same Story The World Over… (earlsview.com)