How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

From: ProPublica

The state’s “character-and-competence” reviews are supposed to weed out operators with histories of violations and fines— but regulators don’t always act on the full story.

SentosaCare homes, which took in nearly $538 million from Medicare and Medicaid in 2013, aren’t the only facilities in the state with repeat violations and low staffing, and several of the company’s homes have above-average ratings on Medicare’s Nursing Home Compare web site, which rates them with one to five stars. (State-by-state inspection reports can be searched on ProPublica’s Nursing Home Inspect, which also lists deficiencies by severity level.)

Medicare Advantage star ratings may change to address fairness complaints

From: Modern Healthcare

By Virgil Dickson

Top CMS officials signaled this week that the agency will consider altering Medicare Advantage quality ratings to adjust for socio-economic characteristics of a plan’s enrollees.

Health plans that primarily serve low-income members and people who are dually eligible for Medicare and Medicaid complain they unfairly get lower star ratings that make them ineligible for bonuses and put them in danger of losing their Medicare contracts. The CMS has the statutory authority to boot a plan if it has fewer than three stars for three straight years.

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Blog: Dialysis providers continue to challenge rating methodology

From: Modern Healthcare

By Sabriya Rice

Kidney-care providers are still battling methods used by the CMS to help dialysis patients evaluate quality at more than 5,500 U.S. treatment centers. The ratings are difficult to understand and are not consistent with other online public-rating systems, a technical expert panel said in a report released Tuesday.

The analysis comes as the providers await the release this month of the newest round of one- to five-star quality ratings, which are meant to summarize how well the facilities did on measures such as reducing hospitalizations, blood transfusion and deaths, among other concerns. In January, the CMS began publicly posting the stars on its Dialysis Facility Compare amid industry protests.