Nursing Homes: CMS Should Make Ownership Information More Transparent for Consumers
Care Compare is a web-based tool that lets consumers compare the quality ratings of health care providers participating in the Medicare program.
We found that the information on owners of nursing homes—both organizations and individuals—isn't organized in a way that allows consumers to identify homes that share the same owners. This makes it difficult for consumers to determine whether a given owner is associated with nursing homes of high or low quality. In addition, some terms used on the website are not defined and may be confusing to consumers.
Our recommendation addresses these issues.
What GAO Found
The Centers for Medicare & Medicaid Services (CMS)—the agency within the Department of Health and Human Services responsible for oversight of nursing homes—collects information on nursing home ownership characteristics. This information includes profit status, names of individual and organizational owners, and chain ownership. CMS also disseminates some of this ownership information on Care Compare, the agency's web-based tool that allows consumers to compare health care providers based on their quality of care and other characteristics. CMS officials told GAO that the agency's goal for presenting nursing home ownership information on Care Compare is to promote transparency for consumers so that they can make informed care choices.
Illustrative Example of Nursing Home Ownership Information Presented on Care Compare
The nursing home ownership information presented on Care Compare does not align with the characteristics of effective transparency tools. For example, Care Compare does not allow consumers to easily identify relationships, such as common ownership, and patterns related to quality across nursing homes under common ownership. Therefore, it is difficult for consumers to know whether a given owner is associated with nursing homes of high or low quality. In addition, Care Compare uses ownership terminology, such as “5% or greater indirect ownership interest,” that is not well defined and could be confusing for consumers. CMS has demonstrated a commitment to improving the transparency of nursing home ownership information and has an opportunity to present ownership information in a way that helps consumers make more informed care choices.
Why GAO Did This Study
CMS provides oversight of the nation's over 15,000 nursing homes that participate in the Medicare and Medicaid programs. This includes ensuring that homes have met certain quality standards. Several studies have shown that the quality of care provided at a nursing home can be related to its ownership. In addition, GAO and others have identified limitations in the transparency and accuracy of information on nursing home ownership.
GAO was asked to report on CMS's use of nursing home ownership information. In this study, GAO examined, among other objectives, the transparency of nursing home ownership information for consumers on Care Compare. To do so, GAO reviewed CMS documentation and interviewed CMS officials, consumer groups, and researchers. GAO also assessed whether the nursing home information on Care Compare aligned with the characteristics of effective transparency tools identified in prior GAO work.
GAO is recommending that CMS fully align nursing home ownership information on Care Compare with relevant characteristics of effective transparency tools. This should include organizing ownership information to allow consumers to identify and examine quality ratings for nursing homes under common ownership, and using plain language to define key terms. The Department of Health and Human Services concurred with this recommendation.
Recommendations for Executive Action
|Centers for Medicare & Medicaid Services||CMS should fully align the nursing home ownership information on the Care Compare website with the relevant characteristics of effective transparency tools. This should include, for example, the following:
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.