Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals for the Five-Star Quality Rating System Are Met

摘要

In 2008, in an effort to provide helpful information to consumers and improve provider quality, the Centers for Medicare & Medicaid Services (CMS) developed and implemented the Five-Star Quality Rating System (Five-Star System). The Five-Star System assigns each nursing home an overall rating and three component ratings-health inspections, staffing, and quality measures-based on the extent to which the nursing home meets CMSs quality standards and other measures. The rating scale ranges from one to five stars, with more stars indicating higher quality. The Patient Protection and Affordable Care Act directed GAO to review CMSs Five-Star System. This report examines (1) how CMS developed and implemented the Five-Star System and what key methodological decisions were made during development, (2) the circumstances under which CMS considers modifying the Five-Star System, and (3) the extent to which CMS has established plans to help ensure it achieves its goals for the Five-Star System. To conduct this work, GAO reviewed CMS documents, interviewed CMS officials and others, and assessed whether CMS uses certain strategic planning practices.