Certified Legal Nurse Consultant Alert: Changes to the Nursing Home Five-Star Quality Rating System

From: LegalNurse.com

Suzanne Arragg

With changes in the Five-Star Quality Rating System affecting the nursing home industry, the Certified Legal Nurse Consultant must understand how Centers for Medicare & Medicaid Services (CMS) collects and relies on data from various data sources.


So what does all this mean? Based on an evaluation of the Five-Star Quality Rating System by Abt Associates, between 2009 and 2013 the percentages of facilities receiving a five-star rating more than tripled and the percentage of facilities receiving one star declined. This finding was attributed to the facilities’ “considerable gaming on the rating system.” [Emphasis added]

What Do CMS Five Star Ratings Really Mean?

In their report, Chemical Restraints: Anti-psychotic meds given to elderly despite warnings, ABC News 10 in Sacramento, CA reports that,

As documented in a coroner’s investigative report, Conover also said she thinks the drugs contributed to her mom’s death just 12 days after she was admitted to Roseville Point Health and Wellness Center.

She was as assessed when she entered Roseville Point as a well developed, well nourished 82-year-old female complaining of back pain to being triaged to Kaiser 10 days later as ill-appearing, obtunded, which is a medical term for being in a vegetative state.


Bill would extend life of low-rated Medicare Advantage drug plans

From: The Herald Tribune

By Maggie Clark

About 10,000 Southwest Florida seniors are enrolled in two poorly rated Medicare Advantage prescription drug plans that could be on the chopping block.

But U.S. Rep. Vern Buchanan, R-Longboat Key, says he wants to make sure those seniors have more time to find a new plan before the low-rated plans disappear.

A bill Buchanan sponsored, known as the “Seniors’ Health Care Plan Protection Act of 2015,” would let low-performing Medicare plans continue to be sold until the end of 2018, instead of the current 2015 deadline.

Medicare’s Hospital Compare adds star rating but fails to score with critics

From: Senior Journal

Editor’s note: New star rating system gets some hoarse criticism at Kaiser Health News

April 16, 2015 – Medicare’s Hospital Compare website may have added the star rating system today but the new service – well, even the earlier service – is not getting five stars from Jordan Rau of Kaiser Health News. His article published today is below. It is a “must read” for senior citizens planning on using the service to choose a hospital.

Only 251 Hospitals Score Five Stars in Medicare’s New Rating

By Jordan Rau, Kaiser Health News

CRE Informs the Media that CMS Star Ratings Could Violate the Data Quality Act

Editor’s Note: CRE has informed Inside CMS, a premier media organization, of potential deficiencies in the CMS Star Rating program.

Editor:  Inside CMS

The following email was sent to a number of individuals associated with the CMS Star Rating System as applied to hospitals.


Jim Tozzi

Center for Regulatory Effectiveness




I am with the CRE, the Center for Regulatory Effectiveness, a regulatory watchdog which intervenes in regulatory proceedings when it appears that government regulations are not science based.

We work to ensure compliance with the Data Quality Act; see the following article from the New York Times http://www.thecre.com/quality/20020321_nytimes.htm