![]() Ten QMs were first added to NHC through the Nursing Home Quality Initiative in 2002 after decades of research creating and validating them ( Zimmerman et al., 1995), including separate measures for short-stay (postacute) and long-stay (chronic-care) nursing home residents. However, many nursing homes calculate and track their own QMs as well ( Davila et al., 2020). These assessment data are submitted to CMS and then converted into facility-level QMs for reporting and for use in inspections. Specifically, the QMs are based on resident assessment data collected by nursing home personnel through the Minimum Data Set (MDS), a standardized tool for care planning and calculating reimbursement. Until several claims-based measures were recently added, the QMs were entirely based on data self-reported by nursing homes. Staffing levels were originally reported by facilities during these inspections, but now facilities report staffing using a payroll-based journal system, still technically self-reported but likely to be more accurate. The inspection results are generated by state Medicaid surveyors who make site visits to each facility approximately annually. The NHC five-star composite rating, first released in 2008, combined information related to three quality domains: inspection results, staffing levels, and clinical quality measures (QMs). This concern is especially relevant when nursing homes with high-reported performance do not perform well on measures that are not based on facility-reported data, such as inspection scores. Specifically, as some of the measures are based on data that are self-reported by nursing homes, it is not clear whether high performance on those measures truly reflects higher quality. Prior research supports modest progress toward both goals, but concerns remain about the validity of the NHC ratings ( Konetzka et al., 2020). Like other public reporting initiatives, two primary goals of NHC (now called Care Compare) are to provide information to consumers to enable a better-informed choice of nursing homes and to provide an incentive for nursing homes to improve the quality of care delivered. In response to longstanding concern about the quality of nursing home care, the Centers for Medicare and Medicaid Services (CMS) created Nursing Home Compare (NHC), a national, web-based, public report card for all nursing homes certified by Medicare and/or Medicaid. Long-term care, Public reporting, Quality Background and Objectives
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