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Nursing Homes: CMS Offers Useful Information on Website and Is Considering Additional Steps to Assess Underlying Data

GAO-23-105312 Published: May 22, 2023. Publicly Released: Jun 21, 2023.
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Fast Facts

The Centers for Medicare & Medicaid Services provides information on the quality of nursing homes as part of its Care Compare tool.

Medicare & Medicaid Services has worked to ensure that nursing home information on Care Compare is useful to consumers and lets them compare data among nursing homes, such as how many nurses a facility has on staff.

However, we found that Care Compare could be improved. For instance, some of the information is not always updated regularly—some of it is more than 2 years old. Our prior recommendations could help the agency improve this website.

A person looking at the website on a laptop

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What GAO Found

GAO found that the nursing home quality information the Centers for Medicare & Medicaid Services (CMS) provides on Care Compare—which was developed to assist consumers in selecting a nursing home—at least partially aligns with 11 of 15 characteristics of understandability and relevancy for an effective transparency tool (see figure). These characteristics include providing descriptions of key differences in clinical quality of care, enabling consumers to customize information, and comparing multiple nursing homes. However, GAO also found Care Compare did not align with four of the characteristics. GAO has made recommendations in the past that apply to some of these characteristics, and for others, CMS told GAO about ongoing efforts to address some of the characteristics GAO identified. For example, CMS officials told GAO they are exploring a way to include information on nursing home residents' experience, which Care Compare currently lacks.


CMS takes various approaches to assess the completeness and accuracy of the sources for the staffing data, inspections, and quality measure information it provides on Care Compare. For example:

Staffing data. CMS has an automated process to check the completeness of staffing data nursing homes report.

Inspection data. CMS uses the Federal Monitoring Survey, which, among other things, replicates recent state inspections to check the completeness and accuracy of inspection results.

Quality measures. CMS has an automated process to check the completeness of the data nursing homes report that inform the measures.

CMS also has processes to assess accuracy, and has recently taken additional steps for one of these measures related to antipsychotic drugs. CMS may audit the nursing home's documentation supporting this measure. CMS recently proposed a validation process for some additional quality measure data represented on Care Compare, though not the rating. According to CMS officials, the agency is exploring to what extent the agency will expand these audits to data that inform the quality measure rating.

Why GAO Did This Study

CMS is responsible for ensuring that participating nursing homes meet federal standards, and provides information on nursing homes' quality on its web-based tool, Care Compare. CMS's Five-Star Rating System, which includes an overall and three component star ratings—health inspection, staffing, and quality measures—is a prominent source of information on Care Compare. CMS has worked to improve its usefulness to consumers, the quality of the underlying information, and aspects of the rating system.

GAO was asked to examine the nursing home section of Care Compare and the Five-Star Rating System. Among other issues, this report (1) examines the understandability and relevance of nursing home quality information on Care Compare, and (2) describes CMS's assessment of underlying information.

GAO reviewed nursing home information on Care Compare against 15 characteristics of understandability and relevancy for effective transparency tools that were identified in previous GAO work. GAO also reviewed CMS's assessment of three of the primary sources of nursing home information for Care Compare: staffing data, inspections, and quality measures.


GAO is making no new recommendations in this report. GAO has made three prior recommendations that, if implemented, would improve consumers' ability to compare nursing homes' cost and quality on Care Compare.

Full Report

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Health care standardsHuman capital managementMedicaidMedicaid servicesMedicareNursing homesProgram transparencyQuality of careConsumersSurveys