From the U.S. Government Accountability Office, www.gao.gov Transcript for: Nursing Home Ratings and Web Site Description: Audio interview by GAO staff with Nikki Clowers, Managing Director, Health Care Related GAO Work: GAO-17-61: Nursing Homes: Consumers Could Benefit from Improvements to the Nursing Home Compare Website and Five-Star Quality Rating System Released: December 2016 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's December 2016. Approximately 15,600 nursing homes that participate in the Medicare and Medicaid programs care for 1.4 million residents each year. To help consumers make informed choices about these nursing homes, the Centers for Medicare and Medicaid Services developed the Nursing Home Compare website, which features a Five-Star Quality Rating System. A team led by Nikki Clowers, Managing Director in GAO's Health Care team, recently assessed this website and rating system to see how useful they were to consumers. Jacques Arsenault sat down with Nikki to talk about what they found. [ Jacques Arsenault: ] Your team looked at the Five- Star rating system for nursing homes. What is this system supposed to do for consumers, and is it effective? [ Nikki Clowers: ] The 5-Star system was developed to help consumers more easily compare nursing homes. The rating system assigns each nursing home a overall rating ranging from 1 to 5. A 1 rating indicates lower than average quality and a 5 rating indicates higher than average quality. [ Jacques Arsenault: ] So, what are some of the things that go into those ratings? [ Nikki Clowers: ] Those include health inspections, staffing, and quality measures. Each of those issues are rated and rolled up into the overall rating. And we found the organizations we spoke to valued the rating system, because it provides standardized, objective information on their nursing home quality. But we did find opportunities for improvement. [ Jacques Arsenault: ] Can you tell me about some of those opportunities? [ Nikki Clowers: ] Sure. We identified a few issues that likely inhibit consumers' ability to use the system as it is intended - that is distinguishing between nursing homes. I'll mention two issues that we found. First, consumers can't use the ratings to compare nursing homes nationally. This is particularly concerning if you live in an area of a state that borders another state, or you have multi-state options. For example, if I lived in Maryland, I may be looking at nursing homes in Maryland, Virginia, West Virginia and Pennsylvania. But what we found is that a nursing home in Pennsylvania with a 4 rating does not necessarily mean that it's of higher quality than a nursing home in Maryland with a 3 rating. This is because the ratings are calculated on a state by state basis. When we recalculated the ratings using a national distribution, we found that the ratings for the nursing homes changed significantly in some cases. The second issue we found is that the rating system does not include consumer satisfaction information-that is, how satisfied are the residents of that home with the quality of the care they've received. This is important because in our analysis we found that nursing homes with higher overall star ratings do not necessarily have higher resident satisfaction scores or fewer complaints. [ Jacques Arsenault: ] And it seems like, from a consumer standpoint, that the health inspections and other measures that go into the rating would certainly be important, but it definitely seems like the consumer experience would be something that I'd be looking at if I were looking at. [ Nikki Clowers: ] Right. We feel like most people would want that type of information. [ Jacques Arsenault: ] You also looked at the Nursing Home Compare website. How helpful is this website for potential consumers? [ Nikki Clowers: ] The CMS website is an important tool for the public. When you're making decisions about nursing homes, it's a stressful time, often, for a family, and sometimes these decisions have to be made in a time sensitive manner. So the website provides good information for those families to use. And it's a piece of information that they can use with all the other types of information that they need to factor in in making those decisions from location to cost to the activities and services provided. [ Jacques Arsenault: ] Can you tell me about the recommendations GAO is making in this report? [ Nikki Clowers: ] We made several recommendations to CMS. I'll highlight three of them for you. First, we recommended that CMS add information that would allow nursing homes to be compared nationally. Second, we recommended that CMS add consumer satisfaction information to the ratings. And third, we recommended that CMS add new explanatory information that will help consumers effectively use the Five Star system. [ Jacques Arsenault: ] And finally, what would you say is the bottom line of this report? [ Nikki Clowers: ] We found that most people find that the nursing home compare website and the five star rating system to be useful and important tools. But they're not perfect. We found in particular that the Five Star Rating System lacks key information that could help consumers make better decisions in terms of the nursing homes and meeting their needs. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.