CMS Quality Star Ratings for Nursing Homes Change Frequently: A Descriptive Analysis of Trends From 2009 to 2020

Nursing Home Compare star ratings are closely watched by hospital delivery systems, policymakers, and consumers as measures of care quality. However, very little is known about the degree to which nursing homes can or do move between star ratings, what we refer to as performance mobility. This study addresses a gap in the literature by examining mobility trends in overall nursing home star ratings.

Descriptive analysis.

We reviewed 2,016,985 monthly ratings for 16,568 unique US Medicare-certified nursing homes.

Using Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data, we constructed a database of the overall monthly star ratings for each nursing home in the United States from January 2009 through February 2020. We began by trending the proportion of nursing homes receiving each rating over time before proceeding to 3 focused analyses on mobility, including (1) the frequency of mobility, (2) the median transition time for each mobility combination, and (3) trends in single-unit changes in rating.

From 2009 to 2020, we observed a general upward trend in overall ratings despite stricter quality requirements, and frequent mobility-both upward and downward-between ratings: 40.32% of 1-star nursing homes later received a 5-star rating, whereas 27.97% of 5-star nursing homes later received a 1-star rating. When these changes between extremes occurred, they took an average of <5 years.

Our findings suggest that nursing home 5-star ratings change frequently and quickly. Performance plays a key role in nursing home selection among patients, and our results suggest that further studies should examine the antecedents and impacts of such changes.