Adding Insult to Injury: How the ACA’s “Fix” for Nursing Home Compare Staffing Data Misses the Mark

The Baby Boomers are aging, and soon many will require more long-term health care services, looking to the Nursing Home Compare Website (Website) to help guide their choices. The staffing rating on the Website, which rates nursing homes on a scale of one to five, uses a biased formula to generate its ratings. It counts registered nurses twice, completely excludes other important care staff, and uses outdated case-mix adjustments left over from the early 1990’s. In light of the pressing need for accurate data but no mechanism to obtain it, the staffing rating must be eliminated from the Website. Some studies suggest that the number of registered nurses in a facility directly correlates with better care, but these studies fail to account for the changing landscape of nursing home populations and advances in medical technologies. In order to avoid misleading consumers making nursing home care decisions, the staffing rating needs to be fixed, but there is no enforcement mechanism in place to ensure that the Centers for Medicaid and Medicare Services (CMS) will do so. Faced with the competing pressures of providing good care within budget constraints while also getting high ratings, nursing homes have come under scrutiny with allegations that they “game the system” by submitting false staffing data to the Website. Section 6106 of the Patient Protection and Affordable Care Act attempts to address this concern by requiring staffing data to be more controlled, but this mandate fails to solve any underlying issues. This paper explores these issues behind the staffing ratings, debunks the dated assumption that more registered nurses inherently leads to better care, and implores CMS to change its ways so that nursing home consumers can make accurately informed choices