Over the past several years, a number of initiatives aimed at giving consumers and other members of the public access to information about nursing home quality have been implemented. In November 2002, as part of its Nursing Home Quality Initiative, CMS began posting on its Nursing Home Compare website [www.medicare.gov/NHCompare/Home.asp] information for each Medicare and Medicaid certified nursing home. The information includes indicators of each facility's performance as measured by ten quality measures. The Nursing Home Compare website benchmarks the facility's performance on these indicators against all nursing home providers in a state and nationally. The Nursing Home Compare website also includes provider-reported staffing information and was recently expanded to include complaint information.
In addition to public reporting efforts by CMS, 20 states have instituted their own public reporting initiatives.16 Of the seven states reviewed for this project, four (Florida, Iowa, Maryland, Texas) have developed a public reporting system. Each of these states makes the data accessible over the Internet. (Internet website addresses and examples of the data reported by these states are shown in Appendix D.) The public reporting systems in these states vary in the type and degree of posted information. Each is intended to provide information to assist consumers in understanding the quality of care provided in each Medicare or Medicaid certified facility in that state. In Florida, Iowa, and Texas, the websites allow access to information about survey results, giving users the ability to drill down to increasingly detailed data about each nursing home--including lists of deficiencies on the most recent survey and a summary of the facility's regulatory compliance history.
Texas bases quality ratings on information from three sources: MDS-based quality indicators, survey deficiencies, and the complaint system. Texas groups and compares providers of similar services (e.g.; community nursing homes are compared only to other community nursing homes, while hospital-based nursing homes are compared only to other hospital-based homes). Quality ratings are presented using a "Consumer Reports" type representation, with a circle ranging from fully darkened to fully open, indicating one of five levels of "quality." The website also provides information on facility ownership, number of beds, and special services offered.
Maryland uses the MDS-based quality indicators developed by the Center for Health Systems Research and Analysis (CHSRA) to compare all facilities across the state. Maryland ranks facilities into three groups: the top 20 percent of all facilities, the bottom 10 percent, and the 70 percent in between. The website in Maryland also includes data on resident characteristics such as gender, age, and functional status.
Nursing home quality information on the Florida website is created from an algorithm, based on the scope and severity of survey deficiencies from the previous 45 months, and compares facilities within geographic areas. Florida ranks its nursing homes by assigning each facility one to five stars. In Florida, several stakeholders voiced approval of the star assessment system, which they felt provided more helpful information than CMS's Nursing Home Compare site. Florida's website also includes information on facility ownership, number of beds, and special services offered. In addition, Florida includes on its website the "Nursing Home Watch List" that identifies all facilities in bankruptcy or certified with a conditional status (indicating that a facility did not meet, or correct upon follow-up, minimum standards at the time of an annual or complaint inspection).
Iowa's site allows users to view all surveys and complaint investigations since June 1999, including those under appeal. This includes full inspection reports, including detailed write-ups of deficiencies and the facility responses or Plans of Correction. The website in Iowa also shows any best practices for which the facility has been recognized.
16. Nursing Home Quality: A National Overview of Public Reporting Programs January 2002 Rhode Island Department of Health, Health Care Quality Series Number 11.