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Supporting and Refining the Five-Star Quality Rating System for Nursing Homes


  • Care Compare for Nursing Homes and its Five-Star Quality Rating System needs ongoing development.
  • In addition to the monthly updates, we’ve made ongoing refinements to the rating system.
  • Studies have found that the website and rating system have incentivized nursing homes to improve quality of care.
The Challenge

When individuals need long-term care, information on provider quality is critical to making an informed choice. The major ongoing challenge in the project is preparing the monthly updates to Care Compare and its Five-Star Quality Rating System to support selection of nursing homes while also making ongoing improvements to the website, for example by incorporating new measures and refinements to the rating methodology and addressing changes to the underlying data. We also conduct ongoing monitoring to understand the effects of changes such as COVID-19 and the new Medicare nursing home payment system that was implemented in late 2019.

The Approach

Abt, under contract to CMS, delivers nursing home quality and other data by supporting Care Compare for Nursing Homes and its Five-Star Quality Rating System. Care Compare includes detailed information on almost all U.S. nursing homes, including numerous measures of regulatory compliance, staffing, and quality of care. The goal of the rating system is to make information on nursing home performance more understandable, enabling consumers to choose high quality providers. Both Care Compare and Five-Star are updated monthly. 

For the monthly updates, Abt runs the data through a sequence of several dozen programs that perform an extensive series of quality checks, calculate the Five-Star ratings and other information displayed on Care Compare, and create a set of downloadable public use files.

We continue to support CMS in developing new measures (including claims-based hospitalizations and ED visit measures and measures of nursing staff turnover), implementing changes in response to the COVID-19 pandemic, and working with other CMS contractors to implement the standardization to its Compare websites that were made in 2020.

The Results

CMS has updated the ratings monthly for more than 12 years. During this time, there have been several major changes to the Nursing Home Compare website and the measures that it reports, including changes several major changes in 2019 and changes that were made in 2020 in response to COVID-19.

The rating system and public reporting of nursing home data are intended to support consumers in selecting high quality nursing homes and to incentivize nursing homes to maintain a high quality of care.  Studies have found that both providers and consumers have responded to the website and rating system. Ratings have increased steadily since the Five-Star Quality Rating System was introduced in 2008, suggesting that providers respond to the incentives introduced by public reporting. There is some evidence of a relationship between higher ratings and more admissions, suggesting that ratings influence consumer choice.