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 Studies: Five-Star Ratings Linked To Consumer Demand, Nurse Training

​Consumers increasingly are more likely to choose a skilled nursing care center if it has a Five-Star Rating of five stars, according to a recent study by Health Services Research. In its study, “Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes,” Rachel Werner, PhD; R. Tamara Konetzka, PhD; and Daniel Polsky, PhD, found that the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System ratings have had a significant effect on consumer choice of high- and low-rated skilled nursing care centers.

A total of 16,147 skilled nursing centers and 2,316,649 nursing center admissions were included, 92 percent of which were admissions for post-acute care. The percentage of admissions to nursing centers with a four- or five-star rating increased beginning in 2009, just after the Five-Star Ratings were released in December 2008. During the same period, the percentage of admissions to nursing centers with a one-star rating declined.

Using the nursing center Minimum Data Set (MDS 2.0) from January 2005 to June 2010 and the Online Survey, Certification, and Reporting (OSCAR) dataset from 2005 to 2010, researchers compared nursing center admission to all Medicare- and Medicaid-certified nursing centers that are also included in the CMS Five-Star Quality Rating System.

The researchers also found significant changes in market share for one- and five-star facilities, based on a simulated market. After the Five-Star rating system was released, centers with a one-star rating lost 8 percent of their market share, and centers with a five-star rating gained over 6 percent of their market share. There were relatively small changes in the market share for two-, three-, and four-star facilities.

“These results are striking and important, but there are nuances to them that policymakers and consumers should consider,” says Konetzka. “Even though people are clearly responding to composite ratings like these five-star ratings, it’s important to realize they combine post-acute and long term care. That’s fine for people needing both, but it doesn’t paint a clear picture for those needing one or the other.”

“Clearly, we are looking at consumer response to the ratings without examining the validity of the ratings,” she says. “There has been a lot of attention on this recently, and CMS continues to work on providing information that reflects quality as whole.”

In other Five-Star news, the American Health Care Association found that skilled nursing care centers employing registered nurses (RNs) certified by the American Nurses Credentialing Center (ANCC) in gerontological nursing are twice as likely to have a Five-Star rating of five. The 2016 study of 100 skilled nursing centers also found correlations between other quality measures:
  • Nursing centers with ANCC-certified nurses are unlikely to have a one-star rating, with only 2 percent of centers receiving the lowest rating;
  • On the Five-Star system quality measures star rating, centers with at least one ANCC-certified RN perform consistently better, with 45 percent receiving a rating of five—12 percentage points higher than the national average;  
  • Centers with ANCC-certified nurses have had on average three to four percentage points lower use of off-label antipsychotics during each quarter of the study; and
  • The rehospitalization rate for centers with ANCC-certified RNs has consistently run at least 2 percentage points lower than the national average since 2011.
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