PROVIDER PERCEPTIONS OF THE CMS 5-STAR RATING AND ORGANIZATIONAL STRATEGIES TO ACHIEVE HIGHER SCORES

摘要

Longstanding concerns about the quality of care provided to nursing home (NH) residents have resulted in creation of new measures of quality and the launching of the NH Compare website, which publically reports measures of quality, including a composite 5-star rating. NHs have responded to these measures by improving scores on many indicators. Yet, we know little about the strategies providers use to improve their ratings and the role of organizational processes in driving improvements. As part of a broader mixed-methods study focused on understanding whether and how NHs are improving care quality, we completed in-depth case studies involving interviews with 40 individuals representing various roles and observations of organizational processes in 4 NHs that varied in their success on NH Compare. We also conducted interviews (n=23) with policy and industry leaders to gain their perspectives. Interviews focused on perceptions of the 5-star ratings, individual quality measures (QMs), the survey process, and facility strategies to improve ratings. NH providers have adopted specific but varied strategies to improve their 5-star ratings, including modifying organizational processes and prioritizing certain QMs. Our findings provide some preliminary evidence that modified organizational processes may be more likely to lead to improvements in care quality than efforts targeted at modifying specific QMs. They also reveal possible unintended consequences of the ratings on providers’ strategies to influence case mix and improve reimbursement, which could be detrimental to quality of care for residents. As the 5-star system evolves, policymakers should consider embedding incentives to avoid these unintended consequences.