Online provider reviews for nursing homes are only consistent with the CMS Star Ratings system about half the time, according to a new assessment from University of California Irvine researchers.
The Centers for Medicare & Medicaid Services (CMS) developed its Nursing Home Star Ratings program as a part of its efforts to drive patient engagement and autonomy in healthcare. By putting clinical quality ratings and information on a publicly available and understandable database, CMS intended for patients and their caregivers to make informed decisions about where to access nursing home care.
But the CMS Star Ratings system may be limited in that it uses clinical quality measures developed by healthcare experts, not the patients who will use the nursing home, to assess value.
And it is that discordance that may have led to a rise in more consumer-facing patient experience and satisfaction ratings, like online provider reviews. These online rating websites, which also exist for other types of medical providers aside from nursing homes, aggregate patients’ qualitative reviews and often star ratings, as well.
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But which patient satisfaction measure is more accurate and more useful for patients making care access decisions?
While all of that may be in the eye of the beholder, this latest research from UCI does shed some light on the differences between online provider reviews and the CMS Star Ratings system.
The study, published in JAMA Network Open, looked at CMS Star Ratings for over 10,000 nursing homes from the last quarter of 2016 and the first three quarters of 2017.
The research team compared key quality measures used to calculate those Star Ratings with a national survey of individuals who visited one of the nursing homes, which was intended to be a controlled stand-in for online reviews.
Specifically, the researchers set to create a system for collecting healthcare consumer sentiment that could be easily integrated into the CMS Star Ratings system.
Overall, the researchers observed agreement between patient reviews and the CMS Star Ratings about half the time. Two of the quality measures included in the study showed moderate concordance, while the remainder of the studied quality measures were the same only about half the time.
These findings suggest patients should have access to both expert and consumer reviews for different nursing homes, the researchers said. Currently, the CMS Star Ratings are the only patient experience reports consumers can access on the CMS website. Although other reviews may exist on different internet platforms, the Star Ratings are the only ones that currently carry the CMS seal.
But the study findings suggest a better path forward, the researchers argued. The finding that CMS Star Ratings only match consumer experience surveys about half the time indicates that there is some information missing on the CMS Star Ratings website from which other consumers may benefit.
“Providing both would allow patients to compare them and, to the degree that they differ, decide whether they are more comfortable with the advice of an expert or another consumer,” the research team said. “One could imagine that, given the choice, consumers and purchasers would prefer to select nursing homes where both the expert-weighted and the consumer-weighted approach assign the highest rating.”
A combined approach would give patients the opportunity to decide how they might weigh the findings from both medical experts and their peer consumers. For example, a potential patient may value the experience of a patient recounting how well her clinician listened to her while staying in the nursing home.
In contrast, a potential patient may value an expert view on adherence to patient safety guidelines.
To be clear, these findings do not invalidate the CMS Star Ratings — in fact, the researchers asserted their findings validate the ranking system. However, it also invites the notion that consumers also add a key component to patient experience reviews that would be beneficial to the CMS Star Ratings website.
Future research may look at the other areas where CMS ranks patient experience, such as their Hospital Star Ratings and Medicare Star Ratings systems. These, too, may see some discordance between consumer sentiment and expert assessment.
Source: PatientEngagement HIT