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How health inspection ratings are constructed

Health inspection ratings are constructed based on a variety of metrics.

How health inspection ratings are constructed

Health inspection ratings and metrics are from the U.S. Centers for Medicare & Medicaid Services (CMS). Nursing homes that participate in the Medicare and/or Medicaid programs have an onsite recertification (standard) “comprehensive” inspection annually on average, with very rarely more than fifteen months elapsing between inspections for any one particular nursing home. Inspections are unannounced and are conducted by a team of health care professionals who spend several days in the nursing home to assess whether the nursing home is in compliance with federal requirements.

These inspections provide a comprehensive assessment of the nursing home, reviewing facility practice and policies in such areas as resident rights, quality of life, medication management, skin care, resident assessment, nursing home administration, environment, and kitchen/food services.

The methodology for constructing the health inspection rating is based on the three most recent recertification surveys for each nursing home, complaint deficiencies during the most recent three-year period, and any repeat revisits needed to verify that required corrections have brought the facility back into compliance.

Scoring calculations

CMS calculates a health inspection score based on points assigned to deficiencies identified in each active provider’s three most recent recertification health inspections, as well as on deficiency findings from the most recent three years of complaint inspections.

Health inspection results

Points are assigned to individual health deficiencies according to their scope and severity –more serious, widespread deficiencies receive more points, with additional points assigned for substandard quality of care (see Table 1). If the status of the deficiency is “past non-compliance” and the severity is “immediate jeopardy” (i.e., J-, K- or L-level), then points associated with a G- level deficiency are assigned.

Deficiencies from Life Safety surveys are not included in the Five-Star rating calculations. Deficiencies from Federal Comparative Surveys are not reported on Nursing Home Compare or included in Five Star calculations, though the results of State Survey Agency determinations made during a Federal Oversight Survey are included.

Repeat revisits

Number of repeat revisits required to confirm that correction of deficiencies have restored compliance: No points are assigned for the first revisit; points are assigned only for the second, third, and fourth revisits and are proportional to the health inspection score for the survey cycle.

If a provider fails to correct deficiencies by the time of the first revisit, then these additional revisit points are assigned up to 85 percent of the health inspection score for the fourth revisit. CMS’ experience is that providers who fail to demonstrate restored compliance with safety and quality of care requirements during the first revisit have lower quality of care than other nursing homes. More revisits are associated with more serious quality problems.