A Regional Assessment of Nursing Home Health Inspection 5-Star Ratings

Authors' Affiliations

Casey P Balio, PhD, Center for Rural Health Research, East Tennessee State University, Johnson City, TN Qian Huang, PhD, MA, MPA, Center for Rural Health Research, East Tennessee State University, Johnson City, TN

Location

D.P. Culp Center Room 311

Start Date

4-5-2024 3:30 PM

End Date

4-5-2024 4:30 PM

Name of Project's Faculty Sponsor

Kate Beatty

Faculty Sponsor's Department

Health Services Management and Policy

Competition Type

Competitive

Type

Oral Presentation

Presentation Category

Health

Abstract or Artist's Statement

Research Objective: The Centers for Medicare and Medicaid Services (CMS) publishes 5-star ratings to assess nursing home quality, intended to provide information publicly to facilitate transparency and consumer choice. The overall 5-star ratings are comprised of several subcomponents, including health inspection, quality measures, and staffing ratings. The thresholds for assigning star ratings, called state cut-points, differ from state to state. The scores and thresholds for the health inspection star ratings specifically are released publicly by CMS. Health inspection scores reflect citations related to patient care and safety standards. The ratings are distributed within a state so that Top 10% of performers within that state receive 5-stars, the Middle 70% is equally distributed between 4, 3 and 2-stars, and the Bottom 20% of performers have a 1-star rating. The purpose of this study is to compare overall 5-star and health inspection ratings among nursing homes in HHS region 4 by state cut-points. Study Design: This cross-sectional analysis examines CMS quality measures of nursing homes by nursing home characteristics and state cut-points using publicly available data. Facility-level data from CMS Nursing Home Care Compare was combined with county-level American Community Survey (ACS) data from Integrated Public Use Microdata Series (IPUMS) National Historical Geographic Information System (NHGIS), RUCC 2013 classifications, Medicaid expansion status from KFF, and community-level Medicare Beneficiary characteristics from CMS. We present descriptive statistics and bivariate analysis of state cut points for HHS Region 4 nursing homes. Results: Among HHS Region 4 states, Alabama has the strictest cut points while Florida had the least strict cut points. When nursing home health inspection scores for facilities in all Region 4 states were recategorized to the stricter state cut points from the state of Alabama, 42.45% of facilities decreased in health inspection star ratings, implying that these facilities would receive a lower score under Alabama’s thresholds. In bivariate analysis, facilities that decreased in star ratings under Alabama's cut points were more likely to be non-profit and metropolitan, less likely to have the smallest bed counts (1-64) and to have median household income in the lowest quartile. When nursing homes were recategorized under the more lenient state cut points from Florida, health inspection star ratings for 26.64% of facilities in HHS Region 4 increased, implying that these facilities would receive a higher score under Florida’s thresholds. Bivariate analysis of the facilities that increased in star ratings under Florida's cut points showed that these facilities were more likely to be non-metropolitan, 2-star or 3-star rated for overall and health inspection score, and to have a median household income in the lowest quartile. Conclusions: When facilities in different states are assessed by a different standard of cut points for the health inspection score, their health inspection star rating could be subject to change. Findings from this study show that differences exist in nursing home facility characteristics that relate to facility quality. Because health inspection 5-star ratings can vary across states the comparison of nursing home quality can be challenging from a consumer perspective.

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Apr 5th, 3:30 PM Apr 5th, 4:30 PM

A Regional Assessment of Nursing Home Health Inspection 5-Star Ratings

D.P. Culp Center Room 311

Research Objective: The Centers for Medicare and Medicaid Services (CMS) publishes 5-star ratings to assess nursing home quality, intended to provide information publicly to facilitate transparency and consumer choice. The overall 5-star ratings are comprised of several subcomponents, including health inspection, quality measures, and staffing ratings. The thresholds for assigning star ratings, called state cut-points, differ from state to state. The scores and thresholds for the health inspection star ratings specifically are released publicly by CMS. Health inspection scores reflect citations related to patient care and safety standards. The ratings are distributed within a state so that Top 10% of performers within that state receive 5-stars, the Middle 70% is equally distributed between 4, 3 and 2-stars, and the Bottom 20% of performers have a 1-star rating. The purpose of this study is to compare overall 5-star and health inspection ratings among nursing homes in HHS region 4 by state cut-points. Study Design: This cross-sectional analysis examines CMS quality measures of nursing homes by nursing home characteristics and state cut-points using publicly available data. Facility-level data from CMS Nursing Home Care Compare was combined with county-level American Community Survey (ACS) data from Integrated Public Use Microdata Series (IPUMS) National Historical Geographic Information System (NHGIS), RUCC 2013 classifications, Medicaid expansion status from KFF, and community-level Medicare Beneficiary characteristics from CMS. We present descriptive statistics and bivariate analysis of state cut points for HHS Region 4 nursing homes. Results: Among HHS Region 4 states, Alabama has the strictest cut points while Florida had the least strict cut points. When nursing home health inspection scores for facilities in all Region 4 states were recategorized to the stricter state cut points from the state of Alabama, 42.45% of facilities decreased in health inspection star ratings, implying that these facilities would receive a lower score under Alabama’s thresholds. In bivariate analysis, facilities that decreased in star ratings under Alabama's cut points were more likely to be non-profit and metropolitan, less likely to have the smallest bed counts (1-64) and to have median household income in the lowest quartile. When nursing homes were recategorized under the more lenient state cut points from Florida, health inspection star ratings for 26.64% of facilities in HHS Region 4 increased, implying that these facilities would receive a higher score under Florida’s thresholds. Bivariate analysis of the facilities that increased in star ratings under Florida's cut points showed that these facilities were more likely to be non-metropolitan, 2-star or 3-star rated for overall and health inspection score, and to have a median household income in the lowest quartile. Conclusions: When facilities in different states are assessed by a different standard of cut points for the health inspection score, their health inspection star rating could be subject to change. Findings from this study show that differences exist in nursing home facility characteristics that relate to facility quality. Because health inspection 5-star ratings can vary across states the comparison of nursing home quality can be challenging from a consumer perspective.