Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

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  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

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  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

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  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

November 18, 2019
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Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar will explore how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
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Do Nursing Homes Inflate Their Medicare Star Ratings By Self-Reporting Overly Positive Assessments?

Why This Study Is Important

Patients, physicians and payers rely heavily on the five-star rating system that Medicare uses to compare nursing homes. The star ratings reflect a base score from an objective, on-site inspection plus two scores from facility-reported information on staffing and quality. Self-reported scores have trended upward, pushing overall ratings higher. This study investigates whether these rating improvements reflect actual quality gains or unjustified ratings inflation.

What This Study Found

  • Nursing homes with more to gain financially from higher ratings are more likely to improve their overall rating through self-reporting.
  • There is little direct correlation between self-reported measures and on-site inspection results, either contemporaneously or over time.
  • The number of resident complaints is similar for nursing homes with the same objectively derived inspection rating but varies appreciably between facilities with the same overall rating, further suggesting inflation in self-reported measures.
  • Models indicate that at least 6 percent of the nursing homes inflate their self-reported measures.
  • Larger and for-profit nursing homes and those with the most to gain financially are more likely to inflate self-reported ratings.

What These Findings Mean

Using several different lines of investigation, this work provides systematic evidence that some nursing homes are inflating the self-reported measures in Medicare’s star rating system. By showing that there is a manageable number of facilities that are likely inflators and identifying key predictors of being an inflator, the findings can help Medicare focus its future audits more strategically and improve its inspection process and ratings system.

More About This Study

This study relies on 2009 to 2013 data for over 1,200 nursing homes in California. The data include the facilities’ star ratings and other characteristics from Medicare files and information on facility finances and resident complaints from other databases maintained by California. The ratings and financial data were used to compute the average daily profit per resident for each star rating level, and ordinal logit models were estimated to assess how the higher profits attainable for higher ratings affect the difference between on-site inspection and overall ratings. Same-year correlations between the inspection and self-reported ratings were examined to identify the degree of internal consistency, and correlations between self-reported ratings in one year and inspection results in the next year were examined to determine if self-reports of high quality are borne out by subsequent inspections. Analysis of variance was used to examine the pattern of complaints for facilities with the same inspection results but different overall ratings and for facilities with the same overall rating but different inspection results. To quantify the likely extent of rating inflation, a predictive model was estimated for the subsample of nursing homes conservatively identified as showing no evidence of rating inflation, and those model parameters were used to predict the highest possible rating for all remaining study facilities. Those with an actual overall rating above their maximum predicted rating were tagged as likely ratings inflators. Variable importance analysis was used to identify characteristics distinguishing facilities that are likely ratings inflators.

Full Citation

Han X, Yaraghi N and Gopal R. "Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System." Production and Operations Management (2017), https://doi.org/10.1111/poms.12804

For more information about this study, contact Dr. Niam Yaraghi at nyaraghi[at]brookings.edu.
For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Dr. Julie Schoenman at 202-296-4426.

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This Research Insights summarizes findings from a study showing that a small percentage of nursing homes—particularly larger and for-profit facilities—are using self-reported scores to inflate their ratings in Medicare's five-star nursing home rating system.

Events

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar will explore how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

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Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

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