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 4 states, selected on factors such as size. GAO also analyzed Five-Star System and consumer complaint data, and analyzed resident satisfaction data from 2 of the 4 states.
What GAO Found
GAO found that the CMS collects information on the use of the Nursing Home Compare website. CMS uses 3 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 found that several factors inhibit the ability of CMS’s Five-Star Quality Rating 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.
GAO is making 4 recommendations:
To strengthen CMS’s efforts to improve the usefulness of the Nursing Home Compare website for consumers, GAO recommends the Administrator of CMS establish a systematic process for reviewing potential website improvements that includes and describes steps on how CMS will prioritize the implementation of potential website improvements.
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, GAO recommends 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;
Develop and test with consumers introductory explanatory information on the Five-Star System to be prominently displayed on the home page. Such information should explain, for example, how the overall rating is calculated, the importance of the component ratings, where to find information on the timeliness of the data, and whether the ratings can be used to compare nursing homes nationally.
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.
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