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U.S. star rating system set for nursing homes

The Baltimore Sun

Nursing homes will get a "star rating" from the federal government to help consumers pick the best facilities, a sweeping initiative that a Maryland regulator predicted will create "peer pressure" among owners to improve care.

The ratings, from a low of one star to a high of five, will be posted starting in December on the Nursing Home Compare Web site of the Centers for Medicare and Medicaid Services, said the federal agency's acting administrator, Kerry Weems.

"I don't think we'll see very many people who are going to be anxious to put a loved one into a one-star home," Weems told reporters yesterday during a conference call.

The CMS Web site provides extensive data on nursing homes, but a star rating system will make it easier for consumers to compare them, said Wendy Kronmiller, director of the Maryland Office of Health Care Quality.

"There is a lot of information out there, but it's not as visually accessible as this would be," said Kronmiller, whose office inspects nursing homes for the government.

Maryland has 233 nursing homes with 28,066 beds.

The CMS plans to decide how many stars each nursing home gets by using data from the past three years of inspections, several measures of quality that include the percentage of residents who have bedsores, and staffing information. He said the agency would consider "other consistent, accurate, reliable data sources."

"The data, and the way that data gets weighted, is open for discussion," Weems said.

The star rating system is the most recent move by the Centers for Medicare and Medicaid Services to increase pressure on nursing home owners - a series of steps that the agency says is designed to protect the more than 3 million people who receive nursing home services each year nationwide.

In November, the CMS began to publish a national watch list of nursing homes that had failed to improve significantly. Homes in the Special Focus Facilities program must be inspected twice a year, instead of once, and face penalties including the possible loss of Medicaid and Medicare funding.

"Our aim, by bringing this information into the sunlight, is to create the catalyst that will push health care to improve at a faster rate," Weems said.

The agency recently placed an icon resembling a stop sign on Nursing Home Compare next to the 131 nursing homes on the list, which includes Manor Care-Rossville in Baltimore County and the Waldorf Center in Charles County.

CMS data show that about half of the nursing homes on the nationwide watch list significantly improve their quality of care within 24 to 30 months and that about 16 percent are terminated from Medicare and Medicaid.

Federal officials are asking for comments about the star rating system. Comments may be sent to, Weems said. Nursing Home Compare can be found at

Kronmiller, whose office is part of the Maryland Department of Health and Mental Hygiene, said the biggest challenge will be using data that produce "fair results" in deciding how many stars each nursing home gets.

She said consumers cannot rely solely on the rating system. For example, low-income people might need to place relatives in a nursing home close to a bus line so they can visit often. And she said it is important to visit a nursing home and meet with staff, residents and other families before making a decision.

"Even that one-star facility could be a good facility, particularly if there are people who care who visit," she said.

A national trade group for nursing homes commended the CMS for deciding to use a star rating system but expressed concern about how the federal agency would determine the number of stars that facilities receive.

Inspections that state governments do on behalf of the CMS "point out problems rather than creating solutions," said Susan Feeney, a spokeswoman for the American Health Care Association. The CMS should also use surveys of nursing home residents and staff members in its star rating system, she said.

Advocates for nursing home residents say there is a lag between when a state government inspects a nursing home or responds to a complaint and when that information is posted on the CMS Web site. Weems said information on Nursing Home Compare is updated every three months.

If the information used in the star rating system is not up to date, relatives could get a "false sense of security," said Dennis Steele, a partner with, a Maryland-based firm that analyzes inspection and complaint data about nursing homes.

"These homes are meeting the minimum government standards, and it does not mean that they are good," Steele said.

Weems said he decided to push for the star rating system after a hearing in which Sen. Ron Wyden, an Oregon Democrat, asked him why it was easier to compare washing machines than nursing homes.

"Sitting there at that table, I remember thinking, 'He's right,'" Weems said.

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