Quality measure rating. CMS Collects Information on the Use of the Nursing Home Compare Website, but Lacks a Systematic Process for Prioritizing and Implementing Improvements

		CMS Collects Information on Website Use

We found that CMS utilizes three standard mechanisms for collecting  information on the use of the Nursing Home Compare website: website  analytics, website user surveys, and website usability tests. Specifically,  the usability tests are not designed to assess the website’s usefulness to  consumers, and the website analytics and user surveys only provide  information about consumers who access the website. However, CMS does not have a  documented and systematic approach describing how to prioritize  recommended changes to the website and assessing the potential  improvements. Instead, officials described a fragmented approach to  reviewing and implementing recommended website changes that may  include verbal discussions of various factors, such as which changes  would provide the broadest impact. CMS has stated the goal for its Nursing Home Compare website as  assisting consumers in finding and comparing information about nursing  home quality. In addition, under federal internal control standards,  management should address identified program deficiencies on a timely  basis and evaluate appropriate actions for improvement. However, in the  absence of an established process to evaluate and prioritize  implementation of improvements, CMS cannot ensure that it is fully  meeting its goal for the website. Several Factors Inhibit the Ability of the Five-Star System to Help Consumers Understand Nursing Home Quality and Choose Between Homes

Our analysis for the Five-Star System’s ratings data found that its overall  rating provided consumers with distinctions between the highest and  lowest performing nursing homes for health inspections in most states. 1. According to CMS Five-Star System documentation, the rating system  is not designed to compare nursing homes nationally. Because the  Five-Star System does not include consumer satisfaction  information—a key quality performance measure—the rating system  is missing important information that could help consumers distinguish  between high- and low- performing nursing homes. To help improve the Five-Star System’s ability to enable consumers to  understand nursing home quality and make distinctions between high-  and low- performing homes, we recommend that the Administrator of  CMS take the following three actions: add information to the Five-Star System that allows consumers to  compare nursing homes nationally; evaluate the feasibility of adding consumer satisfaction information to  the Five-Star System; and develop and test with consumers introductory explanatory information  on the Five-Star System to be prominently displayed on the home  page. We maintain that the ability for  consumers to compare nursing homes nationally is critical to making  nursing home decisions, especially for those consumers who live near  state borders or have multistate options, and that our recommendation  remains valid. We  analyzed Five-Star System data from the Centers for Medicare &  Medicaid Services (CMS). 2. 4. We used the results of 2015 nursing home resident satisfaction  surveys from two of our selected states that collect such  information.
Why GAO Did This Study

Approximately 15,600 nursing homes participating in the Medicare and Medicaid programs provide care to 1.4 million residents each year. To help consumers make informed choices about nursing homes, CMS developed the Nursing Home Compare website, and on the site made available the Five-Star System, which rates homes on quality components.
GAO was asked to assess the website and rating system as tools for consumers. GAO examined (1) the information CMS collects about the use of Nursing Home Compare, including its usefulness to consumers, and potential areas, if any, to improve the website, and (2) the extent to which the Five-Star System enables consumers to understand nursing home quality and make distinctions between homes. GAO reviewed CMS documents and interviewed CMS officials and national and a non-generalizable sample of state-level stakeholders from four states, selected on factors such as size. GAO also analyzed Five-Star System and consumer complaint data, and analyzed resident satisfaction data from two of the four selected states.

What GAO Found

GAO found that the Centers for Medicare & Medicaid Services (CMS) collects information on the use of the Nursing Home Compare website, which was developed with the goal of assisting consumers in finding and comparing nursing home quality information. CMS uses three standard mechanisms for collecting website information—website analytics, website user surveys, and website usability tests. These mechanisms have helped identify potential improvements to the website, such as adding information explaining how to use the website. However, GAO found that CMS does not have a systematic process for prioritizing and implementing these potential improvements. Rather, CMS officials described a fragmented approach to reviewing and implementing recommended website changes. Federal internal control standards require management to evaluate appropriate actions for improvement. Without having an established process to evaluate and prioritize implementation of improvements, CMS cannot ensure that it is fully meeting its goals for the website.
GAO also found that several factors inhibit the ability of CMS's Five-Star Quality Rating System (Five-Star System) to help consumers understand nursing home quality and choose between high- and low- performing homes, which is CMS's primary goal for the system. For example, the ratings were not designed to compare nursing homes nationally, limiting the ability of the rating system to help consumers who live near state borders or have multistate options. In addition, the Five-Star System does not include consumer satisfaction survey information, leaving consumers to make nursing home decisions without this important information. As a result, CMS cannot ensure that the Five-Star System fully meets its primary goal.

What GAO Recommends

GAO is making four recommendations, including, that CMS establish a process to evaluate and prioritize website improvements, add information to the Five-Star System that allows homes to be compared nationally, and evaluate the feasibility of adding consumer satisfaction data. HHS agreed with three of GAO's recommendations, but did not agree to add national comparison information. GAO maintains this is important information, as discussed in the report.