MedPAC Urges Reforms to Nursing Home Five-Star Rating System

The Medicare Payment Advisory Commission (MedPAC) has urged the federal government to reconsider the methodology behind its Five-Star rating system for nursing homes, citing insufficient incentives for quality improvements. MedPAC criticized the current system for its heavy reliance on self-reported data and lack of patient and family satisfaction metrics, which undermine the accuracy and usefulness of quality assessments. It suggests that staffing data, which has demonstrated a clear connection to care quality, should be given greater weight in these ratings. The commission also highlighted concerns regarding the infrequency of surveys, which results in outdated information being provided to consumers via the Care Compare website. MedPAC acknowledged that while CMS has updated the Value-Based Purchasing program, substantial design flaws persist, necessitating congressional intervention to enhance incentive structures. One promising area identified by MedPAC is the Institutional Special Needs Plans (I-SNPs) within Medicare Advantage, which have shown potential in improving preventative care and reducing hospital admissions for nursing home residents. Despite a decline in the number of companies offering I-SNPs, enrollment in provider-sponsored plans continues to rise, reflecting increased nursing home participation. MedPAC plans to further investigate barriers limiting broader I-SNP adoption and explore policies to encourage expansion and improve oversight. This report underscores ongoing challenges in nursing home quality measurement and hints at future policy shifts to balance staffing considerations and care outcomes more effectively within Medicare frameworks.