Nursing Home Response to Nursing Home Compare: The Provider Perspective

Area of Science:

• Healthcare Management
• Quality Improvement in Healthcare
• Geriatric Care

Background:

• The Nursing Home Compare (NHC) five-star rating system aims to inform the public about nursing home quality.
• Controversies exist regarding the validity and impact of the NHC rating system on actual care quality.

Purpose of the Study:

• To explore nursing home administrators' and staff's perspectives on the NHC rating system.
• To identify strategies employed by nursing homes to enhance their NHC scores.
• To understand the alignment between NHC goals and operational realities in nursing homes.

Main Methods:

• Qualitative study utilizing in-depth interviews with nursing home administrators and staff.
• Analysis of interview data to identify themes related to NHC ratings, goals, and improvement strategies.

Main Results:

• Respondents reported conflicting objectives, with revenue maximization and litigation avoidance often prioritized over NHC score improvement.
• Identified strategies for score improvement sometimes involved administrative changes (e.g., coding) without affecting resident outcomes.
• Significant skepticism was expressed regarding the accuracy of self-reported staffing data and the impact of insufficient risk adjustment on rating validity.

Conclusions:

• The NHC system faces challenges due to competing institutional goals and potential biases in self-reported data.
• Refinements to the NHC system should consider incentivizing genuine quality improvement and validating self-reported data.
• Policy adjustments are needed to ensure the NHC system accurately reflects and drives meaningful improvements in nursing home care quality.