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Nursing Homes Performance Rankings Limitations and Considerations

The nursing home rankings are computed using publicly reported data that appear on the CMS Medicare web site (last accessed 3/15/2017). On this web-site CMS displays facility-specific, risk adjusted, performance on 21 quality measures for over 15,000 nursing homes nationwide. In these data, CMS suppresses reporting for agencies with small numbers of cases (less than 30). Thirteen measures that focus on care for long-stay residents were used in the rankings. Patient satisfaction measures are not reported. We advise interpreting this information cautiously and supplementing it with information from the ombudsman's office, the state survey agency, or other sources.


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Data Limitations

  • Nursing home performance measures reflect resident outcomes and therefore require rigorous risk adjustment. Underlying differences in resident conditions or in the types of care provided at the facility may not be fully accounted for by risk adjustment strategies. The best achievable rates for these measures is not well understood at this time.
  • The data presented on the CMS Medicare web site, Nursing Home Compare, come from the national database known as the Minimum Data Set (MDS) repository. All of these data are reported by the nursing homes themselves. Data are reviewed by nursing home inspectors, but not formally audited to ensure that it is accurate.
  • Nursing Home Compare displays data collected on residents between 6 and 9 months ago. Recent changes in performance are not reflected in the rankings.
  • Because of differences in facility size and the clinical conditions of the residents they care for, the number of residents used to compute reported performance rates varies by facility and measure. This impacts the precision with which performance can be ranked.

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Analytic Considerations

  • Each measure used in the rankings was given the equal weight in the analysis regardless of the eligible number of residents for each nursing home or any assessment of the relative importance of the measure.
  • While percentile scores, by definition, always range from 0-100, reported performance on a given measure may cluster very tightly.
  • A single composite performance score or ranking can mask either strong or weak performance in specific measures.

1These measures are:

  • Percent of long-stay residents with pressure ulcers
  • Percent of long-stay residents who lose control of their bowels or bladder
  • Percent of long-stay residents who were assessed and given, appropriately, the pneumococcal vaccine
  • Percent of long-stay residents given, appropriately, the seasonal influenza vaccine
  • Percent of long-stay residents experiencing one or more falls with major injury
  • Percent of long-stay residents who have depressive symptoms
  • Percent of long-stay residents who have/had a catheter inserted and left in their bladder
  • Percent of long-stay residents who lose too much weight
  • Percent of long-stay residents who received an antipsychotic medication
  • Percent of long-stay residents who self-report moderate to severe pain
  • Percent of long-stay residents who were physically restrained
  • Percent of long-stay residents whose need for help with daily activities has increased
  • Percent of long-stay residents with a urinary tract infection
  • Percent of long-stay residents whose ability to move independently worsened
  • Percent of long-stay residents who received an antianxiety or hypnotic medication