Patient Satisfaction News

GAO: Improve Usability, Info on CMS Nursing Home Compare Site

CMS needs to incorporate patient satisfaction scores into its Nursing Home Compare website to improve usability.

By Sara Heath

The CMS Nursing Home Compare website could benefit from updates that improve usability and better inform patient care decisions, according to the Government Accountability Office (GAO).

In a recent audit, GAO found that the Nursing Home Compare website does not meet federal standards for usability testing and improvement. Without a standard testing protocol, CMS will not be able to make the tool more accessible for patients, GAO asserts.


Although CMS employs website analytics, user experience surveys, and website usability and navigability tests with small patient focus groups, GAO found that they do not use the information they glean effectively.

“GAO found that CMS does not have a systematic process for prioritizing and implementing these potential improvements,” the agency reported. “Rather, CMS officials described a fragmented approach to reviewing and implementing recommended website changes.”

According to GAO, federal internal control standards require agencies to formally review, prioritize, and implement improvements for their resources, including the CMS Nursing Home Compare website. Without a formal protocol, CMS cannot meet this requirement.

The report also found that the nursing home comparison function is not entirely valuable for patients. For example, the website does not allow patients to compare nursing homes in multiple states, causing problems for patients who live on the border of two states who may consider accessing a nursing home across state lines.

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The five-star rating system on the Nursing Home Compare website also does not contain patient satisfaction data, limiting the rating system’s effectiveness. Some nursing homes may receive high star-ratings but have low patient satisfaction scores; conversely, some may have poor star ratings but excellent patient satisfaction.

To remedy these issues, GAO provided four recommendations to CMS.

First, CMS should establish an official protocol for assessing and improving the Nursing Home Compare websites consistent with federal requirements.

Second, the agency should revise the comparison process to allow users to compare nursing homes throughout multiple states or across the entire nation.

Third, CMS should consider adding consumer satisfaction data into the five-star rating system.

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And lastly, CMS should develop introductory materials to display on the homepage of the website. These materials could explain how and why consumers should use the five-star ratings and nursing home compare information to make treatment decisions.

“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,” GAO said.

After issuing these recommendations to HHS, GAO said the agency agreed with three of the four. HHS did not agree with the recommendation to enable hospital compare nationwide due to variation in quality surveying in different states.

These findings add to ongoing controversy about the current suite of CMS Compare websites after updates to the five-star rating methodology earlier this year.

CMS intended to refine the system to assist consumers in making informed decisions about their care, officials said in late July.

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“When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones,” said Kate Goodrich, MND, MHS, director of the Center for Clinical Standards and Quality, in a blog post announcing the ratings.

“That’s why over the past decade, the Centers for Medicare & Medicaid Services (CMS) has published information about the quality of care across the five different healthcare settings that most families encounter.”

Some healthcare professionals did not agree, however. Following Goodrich’s announcement, the American Hospital Association issued a statement lambasting the agency for releasing ratings that were not entirely helpful to patients.

“The new CMS star ratings program is confusing for patients and families trying to choose the best hospital to meet their health care needs,” AHA said.

“Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers. And it adds yet another to a long list of conflicting rating and ranking systems.”

Congress was likewise critical of the ratings system, introducing a bill and writing a letter urging CMS to delay its release.

Provided CMS and HHS heed GAO’s suggestions, they may improve the Nursing Home Compare websites and star ratings in such a way that they are both helpful to patients and caregivers and satisfactory for healthcare organizations.

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