GAO: CMS Nursing Home Ownership Information Lacks Transparency

CMS nursing home ownership information does not align with the characteristics of effective transparency tools, according to a report from the Government Accountability Office (GAO).

CMS oversees the more than 15,000 nursing homes in the US that participate in Medicare and Medicaid, ensuring that the facilities meet certain quality standards. Past research has shown that nursing home care quality may be related to their ownership.

CMS collects nursing home ownership information, including profit status, owner names, and chain ownership, to help boost transparency, safety, quality, and accountability. The agency publishes this information on the web-based tool Care Compare, which allows consumers to compare healthcare providers based on their quality of care.

The inclusion of ownership information on Care Compare aims to promote transparency for consumers so they can make informed care decisions, according to CMS.

GAO reviewed CMS documentation and interviewed CMS officials, consumer groups, and researchers to determine whether the nursing home ownership information on Care Compare is presented transparently.

GAO has previously identified characteristics of effective transparency tools, which call for information to be timely, written in plain language with clear graphics, and organized in a way that highlights patterns. In addition, the tool should enable easy use and navigation, explain the purpose and value of the information, and describe key strengths and limitations.

The report found that the nursing home ownership information on Care Compare is not sufficiently transparent for consumers and only aligns with the timely characteristic. The information uses terminology that consumers may not understand and does not allow consumers to identify relationships and patterns across nursing homes.

For example, consumers cannot easily see common ownership and quality patterns across facilities, making it difficult to know whether a given owner is associated with high- or low-quality nursing homes.

The website also uses ownership terminology like “5 percent of greater indirect ownership interest,” which is not well defined and may be confusing for consumers.

GAO recommended that CMS fix the nursing home ownership information on Care Compare to align with the characteristics of effective transparency tools. For example, the agency should use plain language to define key terms in the ownership section of the website.

Additionally, the information could be organized to give consumers easy access to a list of facilities under common ownership, their star ratings, and the distribution of star ratings across nursing homes with shared ownership. This would allow consumers to assess quality patterns across facilities.

HHS agreed with the recommendation and also noted that CMS is gathering feedback from consumers on how to best present provider ownership information in a user-friendly way on Care Compare.