Published: August 15, 2018

The Centers for Medicare & Medicaid Services (CMS) identifies some of the worst performing nursing facilities in the country as Special Focus Facilities (SFFs).  This Report looks at one of the four categories of SFFs – those that “have not improved” – and how they game and manipulate CMS’s Five-Star Quality Rating System.

As discussed more fully below, the most striking finding in this analysis is that 13 of 33 SFFs (39%) that CMS identified as not having improved had five stars in their self-reported quality measures domain, leading to an upward adjustment from one star to two stars for their overall ratings.

Edelman, Toby. “Special Focus Nursing Facilities That ‘Have Not Improved:’ Poor Care for Residents, Overall Ratings Artificially Boosted by 5-Star Ratings in Self-Reported Quality Measures.” Center for Medicare Advocacy, 15 Aug. 2018, medicareadvocacy.org/special-focus-nursing-facilities-that-have-not-improved.