Public Quality Reporting and Nursing Home Admission Decisions

To the Editor:It’s been 20 years since CMS launched Nursing Home Compare, now Nursing Home Care Compare (NHCC), a web-based consumer resource outlining care quality in nursing homes (NHs). Quality metrics are summarized in scorecards grading each facility using a 5-star rating. When the National Quality Forum developed the long-stay quality-measures, they purposefully incorporated only minimal adjustments for resident risk with few, well-defined exclusions.1 A disadvantage of using unadjusted quality scores is the tendency to underestimate the care quality provided to less healthy patients.