Title: Nursing Home Ownership Can Affect the Quality of Care, And Clearer Information Could Help Families' Decision-making Description: Who owns a nursing home is often an important factor impacting the quality of care residents living in that home receive. For nursing homes that participate in Medicare and Medicaid programs, ownership information is shared with the public so that families can compare health care providers and gain some transparency about the quality of care their loved ones receive. However, we found important information that could help families make decisions is often missing or hard to understand. We'll find out more from GAO's Leslie Gordon. Related GAO Work: GAO-23-104813, Nursing Homes: CMS Should Make Ownership Information More Transparent for Consumers Released: February 2023 [Music] [Leslie Gordon:] CMS needs to make nursing home ownership information more transparent and available to the public. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. Who owns a nursing home is often an important factor impacting the quality of care residents living in that home receive. For the more than 15,000 nursing homes that participate in Medicare and Medicaid programs, ownership information is shared with the public so that families can compare health care providers and gain some transparency about the quality of care their loved ones receive. However, in a new report, we found important information that could help families make decisions is often missing or hard to understand. We'll find out more from GAO's Leslie Gordon, an expert on Medicare and Medicaid programs and a director in our Health Care team. Thanks for joining us. [Leslie Gordon:] My pleasure, Holly. [Holly Hobbs:] So, Leslie, why does it matter who owns a nursing home facility? What could that information tell us about the quality of care provided? [Leslie Gordon:] Ownership matters because owners make decisions that can affect the quality of care in a nursing home. We know from research that certain ownership characteristics--like for-profit status and chain ownership--can be associated with lower quality of care and lower staffing areas. And wouldn't you want to know if the owner of a nursing home that you were going to potentially be in as a resident or for a family member, wouldn't you want to know if they had other nursing homes that had high quality or poor quality? [Holly Hobbs:] So how is this information being shared with the public? [Leslie Gordon:] Currently, the Centers for Medicare and Medicaid Services has a website called Care Compare. It's designed to share all kinds of information with the public so that they can make informed decisions about nursing homes. The Care Compare website has information about the overall quality of a facility. It has information about the staffing ratios and health inspections. It also contains information about ownership. So that's the primary way that CMS is sharing this information with the public. [Holly Hobbs:] We looked at Care Compare and the information it provides families. What did we find? [Leslie Gordon:] Well, the quality information is fairly straightforward. They use a five star rating system. The ownership information, on the other hand, isn't so easy to understand. We looked at it in terms of the use of plain language, from being able to connect which nursing homes are owned by the same owner, and ease of navigation. And we found that the ownership information on the website was hard to follow. There were terms like managerial control and 5% general indirect interests. You know, it's hard to know what that means in terms of ownership. More importantly, Care Compare doesn't necessarily identify all the homes that are owned by the same owner. So there's no way to look at the quality rating across all of the nursing homes owned by the same owner. [Holly Hobbs:] And you said that the Centers for Medicare and Medicaid Services (CMS) is the federal agency that's collecting and sharing this information. But beyond sharing it with the public, how else is CMS using ownership information? [Leslie Gordon:] Primarily, the ownership information is used when the nursing home is being enrolled as an eligible Medicare provider. The ownership information is examined and screened against a number of databases to make sure owners haven't committed a felony or been convicted of or brought up on fraud charges, and that they are licensed, insured and eligible to participate in the Medicare program. CMS has also, on occasion used ownership information as a part of its quality check. But this is a very occasional use. I'll give you one example that is a really strong and it shows how ownership information could be more useful in helping assure quality. CMS told us that they were noticing a pattern of high use of antipsychotic medication in a group of homes that were part of a regional chain. And when they noticed this, they called the chain's owners attention to these findings, and they sat down with the owners, created a plan to reduce antipsychotic use, and then in later quality assessments of the nursing homes owned by those owners, they saw a decline in the use of antipsychotic medications. {MUSIC} [Holly Hobbs:] So Leslie told us that the Centers for Medicare and Medicaid Services provide information to the public about nursing homes that is not always easy to understand or clear. And on occasion, CMS also uses this information to monitor quality of care issues across facilities that have the same owner. So, Leslie, given some of the issues that we identified with the information provided to the public on nursing home ownership and how it's used, what more do we think CMS should be doing? [Leslie Gordon:] CMS should be making the ownership information on Care Compare more transparent and accessible. We think they need to define the terms that they're using around ownership to make it clear what the different categories of ownership are and what that means. We also think that they should find a way to make it easier for users to understand the quality across a chain of nursing homes that have a common owner. Something like their five star quality rating across all the nursing homes, we think would be very informative. [Holly Hobbs:] And last question, what's the bottom line of this report? [Leslie Gordon:] CMS needs to make nursing home ownership information more understandable to the public. So that when people who have to make the tough decision of choosing a nursing home for their family member, they're fully informed about who owns the nursing home. [Holly Hobbs:] That was Leslie Gordon talking about our new report on nursing home ownership. Thanks for your time, Leslie. [Leslie Gordon:] My pleasure, Holly. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify, or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.