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How QRS Evaluates Nursing Facilities that Accept Medicaid or Medicare

   Overview      Comparisons      Quality of Care      Facility Inspections      Quality Profiles      Rating Scales

Go To TopOverview: Nursing facilities that accept Medicaid or Medicare are compared in QRS on the basis of two dimensions that depict some important aspects of quality. Quality has many dimensions. The quality of care provided to nursing home residents, the quality of life each resident experiences, the ability of a facility to meet all regulatory requirements, and customer satisfaction are all important aspects of quality. QRS uses four quality dimensions or axes to rate nursing facilities.

A brief background history of QRS development as well as answers to providers' frequently asked questions are available on the QRS Provider FAQ page.

Interpret QRS ratings cautiously. QRS nursing home ratings are based on a reporting period that tends to indicate each facility's recent performance. QRS ratings do not indicate facility performance over the long term. Further, because QRS is only updated monthly, it is possible that very recent performance problems will not be reported. Even a facility that appears to have favorable QRS ratings may be under sanctions or penalties due to performance problems that occurred outside the QRS reporting period. The Regulatory Compliance History and Events and Actions sections of each facility's quality profile contain additional historical information that can help you to better judge the consistency of facility performance over time.

Use QRS information to help you make a nursing facility selection rather than as a short-cut to finding the best nursing home. You may also contact the DADS Consumer Information Hotline at 1-800-252-8016 or via e-mail to request additional consumer information about a particular facility.

Go To TopComparisons: QRS uses comparison tables to show ratings for nursing facilities that accept Medicaid or Medicare. These comparison tables include an overall rating score for each facility. Interpret this overall score with caution. The overall rating is the sum of the four quality axes scores divided by the total points possible. It arbitrarily assigns equal importance to all four quality axes. As you read individual facility quality profiles, you will need to decide whether these axes are indeed equally important to you.

Nursing facilities are listed in the comparison tables from highest overall rating to lowest. When several facilities earn the same overall rating, they appear in alphabetical order. Thus, if facilities South Village, West Oaks and Davis Retirement Center all have the same overall rating, they will appear in the comparison table in the order Davis Retirement Center, South Village and West Oaks.

Go To TopFacility Inspections: The QRS Investigations and Inspection scores are direct measurements of quality. The scores rate the facility's compliance with all applicable regulations and requirements.

Investigations Score: DADS investigates all complaints that come to its attention concerning nursing homes. Substantiated complaint allegations that constitute a violation of state or federal regulations are usually cited by DADS as nursing home deficiencies. The Investigations Score is based on the nature, severity and scope of the deficiencies cited in each home during the preceding six months.

Inspection Score: A DADS inspection team also inspects each nursing home at least once every 15 months (every 12 months on the average). The results of the most recent routine inspection determine the Inspection Score. This rating may not be a sensitive quality measure if the most recent inspection occurred many months earlier; the quality of any service can change markedly over the course of a year.

NOTE CAREFULLY: The number of deficiencies does not determine the compliance score; it is the nature, scope, and severity of the most severe deficiency that determines the score. A nursing home cited for a deficiency has a right to appeal the citation, and there are occasions on which such appeals lead to the reversal of even the most severe deficiencies. Therefore, both the Complaint and Inspection ratings can appear to be poor only to suddenly improve as the result of such a reversal. In order to provide the most accurate ratings possible, all ratings are recalculated each month.

Potential Advantages Score: If a facility has a quality measure percentage that is lower than 90% of all nursing facilities in Texas, it receives a potential advantage for that quality measure. To determine whether the facility has met the criteria for a potential advantage, the facility is compared to all other facilities. If it has a percentage of people triggering the quality measure that is lower than 90% of all other facilities? percentages, it will receive a potential advantage.

The more quality measures for which a facility has a potential advantage, the more favorably it will be rated on the Potential Advantage Score (PAS).

The denominator of the quality measure is the number of people who could trigger the quality measure, whether or not they do. For a facility to be eligible for a potential advantage on a quality measure, the denominator must be greater than 10.

Potential Disadvantages Score: A facility compares unfavorably to other facilities on a quality measure. If a facility has a quality measure percentage that is higher than 90% of all nursing facilities in Texas, and the denominator for the quality measure is greater than 10, the facility will be listed as having a potential disadvantage for that quality measure. The more quality measures for which a facility has a potential disadvantage, the less favorably it will be rated on the Potential Disadvantage Score (PDS). The denominator of the quality measure is the number of people who could trigger the quality measure, whether or not they do. For a facility to be eligible for a potential advantage on a quality measure, the denominator must be greater than 10.

Go To TopQuality Profiles: QRS can show a quality profile that explains the facts behind the ratings assigned to a facility. This additional information may help you decide whether the facility is one that you want to consider further. The profile is a written report that includes the following:

Go To TopRating Scales: Each QRS rating scale consists of five rating symbols. A sixth symbol, NR, is used to show that the facility could not be rated for lack of information. The rating symbols range from Most Favorable - the most favorable rating to Least Favorable - the least favorable rating. Holding the mouse pointer over any rating symbol for a few seconds will show a brief description of a rating symbol on any QRS page. Most Web browsers will show the text explanation for any picture when this is done. The precise meaning of each symbol in each rating scale is given in the tables below.

PAS is rated according to the following scale.
Most Advantages Most Advantages. More than 80% of other facilities.
More Advantages More Advantages. More than 60% and less than or equal to 80% of other facilities.
Some Advantages Some Advantages. More than 40% and less than or equal to 60% of other facilities.
Fewer Advantages Fewer Advantages. More than 20% and less than or equal to 40% of other facilities.
Fewest Advantages Fewest Advantages. Less than 20% of other facilities.
No Rating Available No Rating Available.

PDS is rated according to the following scale.
Fewest Disadvantages Fewest Disadvantages. Less than 20% of other facilities.
Few Disadvantages Few Disadvantages. More than 20% and less than or equal to 40% of other facilities.
Some Disadvantages Some Disadvantages. More than 40% and less than or equal to 60% of other facilities.
More Disadvantages More Disadvantages. More than 60% and less than or equal to 80% of other facilities.
Most Disadvantages Most Disadvantages. More than 80% of other facilities.
No Rating Available No Rating Available.

The investigation and inspection scores are based on the following scale.
Total Compliance In total compliance with regulations. No deficiencies were cited.
Substantial Compliance In substantial compliance with regulations. No cited deficiency resulted in actual resident harm or immediate jeopardy or had more than potential for minimal resident harm.
Out of compliance/No harm or jeopardy Not in substantial compliance with regulations. A cited deficiency had the potential for more than minimal harm but did not cause residents either actual harm or immediate jeopardy and did not constitute Substandard Quality of Care.
Out of compliance/Actual harm or jeopardy Not in substantial compliance with regulations and having at least one deficiency that caused actual resident harm or jeopardy to resident health or safety. A cited deficiency either caused actual resident harm or constituted immediate jeopardy to the Health or Safety of residents but did not constitute Substandard Quality of Care.
Substandard Quality of Care Substandard Quality of Care. A cited deficiency involved regulations that govern Quality of Care, Quality of Life, or Resident Behavior and Facility Practices such that: 1) there was a widespread occurrence with more than the potential for minimal harm, 2) there was a pattern or widespread occurrence of actual harm, or 3) there was immediate jeopardy to the Health or Safety of at least one resident.
No Rating Available No Rating Available.

Caution: This web site does not reflect recommendations of any specific provider by DADS. It is simply a tool that you can use to help you make a selection. Because QRS shows information from a limited time period and is updated only once each month, it may not include some important events that are either older or more recent. QRS rating systems are developed in collaboration with long term care providers and consumer advocates and may include some self-declared and unverified information.

DADS strongly encourages you to visit with providers that you consider and talk with people who receive services from them. To obtain the most recent information about a provider, contact DADS Consumer Information Hotline at 1-800-458-9858. For general inquiries, send an email to LTCSearch@hhsc.state.tx.us.

Last Update 02/22/2017