Review of Veterans Health Administration Community Living Centers and Corresponding Star Ratings

In response to a congressional request, the VA Office of Inspector General (OIG) conducted a review to examine the Community Living Center (CLC) rating system (Compare), the rating system’s limitations, and what information from the system can reasonably be used to understand the long-term care delivered at CLCs. The OIG found that using star ratings produced by Centers for Medicare and Medicaid Services (CMS) Compare and CLC Compare to examine quality differences between CLCs and CMS participating nursing homes is problematic for several reasons including methodological differences in how the two rating systems collect and analyze data. While metrics can provide a starting point for where to focus additional oversight or areas for potential improvement, they should not be used as a proxy for the overall quality of a facility. Given the complexities and variability among facilities, a single rating score does not, and cannot, provide a comprehensive assessment of a healthcare facility. While these ratings provide selective information about what is occurring in CLCs, they often do not reveal the root cause of the issue or what action should be taken to address a situation if necessary. Despite the limitations associated with using CLC Compare, problematic evaluations still raise concerns about quality of care. It is incumbent on VA to determine whether such evaluations reflect shortcomings in the rating system or the care delivered. The evaluations necessary for these determinations could provide a basis for an improved rating system. The OIG made three recommendations to the Under Secretary for Health related to supplementing CLC Compare with adjustment measures to address CLC and Center for Medicaid and Medicare Services comparison challenges, and developing (a) measures with more rigorous risk adjustment for CLC staffing and quality performance, and (b) a resource that provides an understandable narrative for all.