A new nationwide quality rating system for nursing homes just unveiled by federal officials was released prematurely and may confuse consumers more than help them, according to the U.S. General Accounting Office.
In a 40-page report issued on the same day the disputed rating system began appearing in full-page newspaper ads, the investigative arm of Congress said it had serious questions about the validity of the data used to rate the homes.
"GAO has serious concerns about the potential for public confusion by the quality information published," the report states.
The GAO had urged the Centers for Medicare and Medicaid Services to delay the release of the survey data until studies were completed. The advice was declined, and the data began appearing yesterday in 71 newspapers across the country, according to CMMS spokesman Rob Sweezy. He said the cost of the ads was "less than $3 million."
"We welcome the [GAO] report," said Sweezy, adding that his agency remained convinced that the data on some 17,000 nursing homes will prove useful to consumers. He said that surveys in states, including Maryland, where the program was started on a pilot basis showed high consumer satisfaction.
The GAO, however, faulted the federal agency for moving forward with national data before the centers had completed an evaluation of the pilot program. GAO auditors noted that a separate review by a private consulting group also remains to be completed.
One factor that the GAO said could likely lead to confusion is that the data provides seemingly contradictory information.
"Almost one-fifth of the homes in pilot states had an equal number of highly positive and highly negative quality indicator scores," the report states. The GAO also warned that nursing homes with very high overall ratings in the survey may still have serious health care quality problems.
Conversely, Carol Benner, director of the Office of Health Care Quality in Maryland, noted that facilities specializing in the care of patients with serious problems, such as Alzheimer's disease, may appear to do poorly in some categories when they in fact provide superior care.
GAO auditors said that the ratings also give a false sense of precision. The ratings, the auditors stated, were "neither consumer-friendly nor reported in a format consistent with the data's limitations."
The GAO also found that consumer hot lines set up to explain the data to consumers only made matters worse. When GAO staffers called the hot line, they were "provided erroneous or misleading data," the report states.
Only two of the nine persons assigned to answer consumer inquiries were generally knowledgeable about the survey data. The remainder were unable to answer even simple questions, the GAO said.
In Maryland and several other states, consumers can turn to a separate state nursing home rating system run by the Maryland Health Care Commission. The data can be accessed on the Internet (www.mhcc.state.md.us).
"We believe our system gives a better overall picture," said commission director Barbara McLean. She said adjustments and improvements in the state data will be implemented shortly.
There are also privately run rating systems. Some, such as Member of the Family (memberofthefamily.net), are available on the Internet. The new federal data can be found at www.medicare.gov.
Benner said that the best advice for consumers is to review all the different surveys and, most important, visit the homes "during the day, at night and during the shift changes. It's all part of the puzzle."