VA extends record of transparency with first-ever posting of annual nursing home ratings

Yesterday, VA extended its unprecedented 18-month record of transparency disclosures by making public for the first time its annual nursing home ratings. View the ratings here.

The data show that, overall, VA’s nursing home system – composed of more than 130 community living centers – compares closely with private sector nursing homes, even though the department on average cares for sicker patients in its nursing homes than do private facilities.

In fact, the overall star rating for VA’s nursing homes compared to the 15,487 private sector nursing homes rated by the Centers for Medicare and Medicaid Services shows that VA has a significantly lower percentage (34.1 percent lower) of one-star, or lowest rated, facilities than the rest of the nation.

Of note, 60 of VA’s nursing homes improved their quality score from last year to this year (2^nd Quarter FY17 to 2^ndQuarter FY18).  Only one facility had a meaningful decline in that metric, and that facility was already rated with four stars.

Extending President Trump’s commitment to VA transparency and quality improvement

For years, the Obama administration had resisted making certain VA quality data public. But under President Trump’s leadership, transparency and accountability have become hallmarks of VA.

That’s why VA has become the first hospital system in the nation to post its:

• Hospital wait times
• Opioid prescription rates
• Employee settlementsand accountability actions
• Chief executive travel

“Now that VA has made a commitment to reporting accurate quality and comparative data on its nursing homes, we are pleased to begin adding that important information to our transparency portfolio for the benefit of Veterans in making their health care choices,” said Acting VA Secretary Peter O’Rourke. “Further, we will release this data annually and use it to drive improvements across the VA nursing home system, including aggressive efforts to improve our 11 one-star facilities by sharing best practices.”

How VA nursing homes compare with the private sector

The best comparison of VA nursing homes to the private sector is in the overall star rating. Using that overarching and most important metric, VA’s performance compares very closely with that of the private sector. See here for a comparison of quality ratings using Centers for Medicare and Medicaid Services’ Nursing Home Five-Star Quality Rating System as of April 2018.

VA’s unique patient base

Of note, VA nursing homes often serve residents with more numerous and challenging medical conditions than do private sector facilities.

Specifically, VA nursing homes serve a much higher proportion of residents with conditions such as prostate obstruction, spinal cord injury, mental illness, homelessness, PTSD, combat injury, terminal illness and other conditions rarely seen in private nursing homes.

Also, private sector nursing homes admit patients selectively, whereas – unlike the private sector – VA will not refuse service to any eligible Veteran, no matter how challenging the Veteran’s conditions are to treat. In other words, VA nursing homes often house residents with more complex medical needs that private sector facilities will not accept, which makes achieving good quality ratings more challenging.

As a result, VA nursing homes at times rate lower than private sector facilities on specific metrics such as pain and type of treatment. Despite that fact, VA nursing homes compare well with private sector facilities in overall facility rankings.

VA nursing homes provide more direct nursing care

Additionally, VA nursing homes have a higher staff-to-resident ratio than private sector facilities, meaning residents in VA facilities get more direct attention from nursing home staff than do residents in the private sector facilities.