The Centers for Medicare & Medicaid Services on Wednesday announced it is making major changes to its Care Compare site, including the elimination of old, third-cycle inspection results from its health inspection rating.

About 20% of nursing homes could see their ratings change — for better or worse — as a result.

“Historically, any inspection in the third cycle (i.e., the oldest standard survey) would not be over 45 months old. However, due to a backlog, there are currently health inspections in this cycle that are older than 45 months that are still used to calculate ratings,” the agency said, citing COVID access issues and a flatline budget that has prevented hiring more surveyors.

“While there have been improvements in the backlogs, CMS believes that third-cycle standard health inspections may not accurately reflect the current performance of nursing homes, given their age. Therefore, CMS will no longer use the three most recent standard surveys and will only use the two most recent standard surveys for the health inspection rating calculation beginning in July 2025.”

In a memo from the Center for Clinical Standards and Quality to state survey agencies, CMS said preliminary analyses indicate this change “will have minimal impact on overall ratings, with most facilities maintaining their current health inspection ratings.”

The agency said ratings will not change for about 80% of facilities. Ratings for the other 20% will shift up or down, depending on whether their two most recent surveys are better than their oldest one.

Nursing homes have clamored for the change, noting consumers are misled by the inclusion of outdated information and ratings included on the Care Compare site.

CMS said it would continue to use a three-year lookback period for complaint and infection control inspections, but shift survey weights to better emphasize the most recent cycle. 

“Ultimately, this gives consumers a better picture of a nursing home’s current quality level,” the memo said.

In the same memo, CMS said it also would begin posting aggregated performance information for nursing home chains on Care Compare in a “consumer-friendly format.”

Currently chains’ average ratings and performance measures are posted on a data website mostly used by stakeholders and researchers.

Starting July 30, CMS will publish performance information (average overall 5-star ratings, health inspection, staffing, and quality measure ratings) for each chain directly on Nursing Home Care Compare.

“This will increase the transparency of nursing homes’ ownership and control for consumers, allowing them to make more informed decisions about their care,” CMS said.

CMS said it would also incorporate an updated long-stay antipsychotic measure starting Oct. 29.

The new measure of long-stay receiving an antipsychotic medication will be calculated using Medicare and Medicaid claims and encounter data, in addition to the Minimum Data Set data already used.

The agency said the existing proportion of US nursing home long-stay residents receiving an antipsychotic is 14.64%, which will increase to 16.98% with the broader collection effort meant to improve accuracy. For star rating calculations, the cut points for the replacement measure will place providers into 10 equal deciles based on performance distribution.

CMS said the fact that MDS-reported exclusion diagnoses will be validated with claims and encounter data would reduce the number of excluded residents due to the overreporting of schizophrenia diagnoses.

Finally, CMS said it would removing COVID-19 vaccination measures for residents and staff from each nursing home’s Care Compare profile page effective July 30.

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