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CMS Five-Star Nursing Home Rating System Shows Good Intent, But Premised On Flawed Survey System  
CMS Five-Star Nursing Home Rating System Shows Good Intent, But Premised On Flawed Survey System
AHCA Says New System Does Not Appropriately Assist Consumers

Contact: Katherine Lehman
(202) 898-2816


Washington, DC –The American Health Care Association (AHCA) said the Centers for Medicare and Medicaid Services’ (CMS’) new “Five-Star” rating system unveiled today is premature and problematic due to the fact that it is premised upon a flawed survey system that does not measure quality, lacks the inclusion of other important quality elements that help consumers make informed decisions, and includes inaccurate data.

“While AHCA is committed to enhancing quality in our nation’s nursing homes, we do not believe that an index which is based on the flawed survey system will provide consumers with the accurate, timely information they need to assess the quality of a facility,” stated Bruce Yarwood, President and CEO of AHCA. “Just as every one of our nation’s nursing home residents deserves the highest quality nursing home care, consumers deserve accurate, consistent and comparable data when choosing a nursing facility for a loved one.”

The AHCA President and CEO made the key observation that “Five-Star” will not achieve its goal of providing better tools to consumers nationwide as individuals will not be able to use this system to compare facilities across states.

Fundamentally, AHCA disagrees with the fact that the “Five Star” system places the most importance on the survey component when determining a facility’s overall quality rating. The association pointed out shortcomings with the rating system, including the fact that the staffing component fails to reflect all caregivers within a facility. Yarwood also noted that the index itself fails to include the critical input of residents and staff who have received and provide care in any given facility.

“Quality improvement is a dynamic, ongoing process – and its quantification must reflect the many variants that go into the delivery of care,” Yarwood continued. “Today’s survey system does not specifically measure quality – it assesses compliance with federal and state regulations. While the survey system is not unimportant, we believe that customer satisfaction – and how a resident and family members judge the actual care being provided in a particular facility – is a superior indicator of the quality of care and quality of life experienced by residents.” 

Yarwood cited the June 2008 My InnerView, Inc. national report on customer satisfaction with nursing facilities, which indicated that  83 percent of the respondents rated overall satisfaction with their nursing home as “excellent” or “good” and fully 82 percent of the respondents said they would recommend the facility to others.

Yarwood noted one of the keys to improving the collaborative process between providers and a regulatory authority – and a key to helping facilities in need of improvement – is expanding the concept of transparency beyond just facilities to include the survey and enforcement process itself. AHCA has been working in coalition with other long term care providers including CMS, quality improvement experts, medical professionals, and consumers on the Advancing Excellence in America’s Nursing Homes campaign, which builds on the ongoing Quality First initiative.

“Our profession has helped lead the nation's healthcare sector in terms of quality improvement, and we are committed to continuing our strong working relationship with CMS to advance a transparent survey process that recognizes quality, provides the resources for facility improvement, enhances every facility’s efforts to improve patient care, and mirrors our profession’s own quality improvement initiatives.”

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 13,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit or