New nursing home app organizes Medicare rating data

By Jean Lotus Staff Reporter
Joel Inwood and other Chicago “civic hackers” created an app that loads live Medicare ratings to help residents learn about healthcare costs.

Joel Inwood and other Chicago “civic hackers” created an app that loads live Medicare ratings to help residents learn about healthcare costs.

The state of Illinois has about 1,200 nursing homes and long-range care facilities, but reported quality of care varies widely from place to place.

That data really became clear to Joel Inwood and other “civic hackers” when they loaded nursing home ratings data from Medicare onto a digital map and took a look.

“You just have all these red dots everywhere, which indicates the poorest-performers, right next to the green dots with the best ratings. In rural America, you may have a choice of maybe five nursing homes when you’re looking for someplace for your loved one,” said Inwood. “In Chicago, Cook and collar counties, you might have facilities right next to each other with widely different ratings.”

Inwood and a group of volunteer coders officially launched their open-source nonprofit website on Nov. 29 at the Chicago  Hack Night gathering at the Merchandise Mart.

The site crunches numbers from the U.S. government’s Medicare Five-star ratings system and posts them in real time. The site covers nursing homes in Cook, Lake, Kane and Will Counties.

“Medicare has a lot of data out there,” Inwood said. “The problem is, it’s just a glut of data and that makes it hard to do any research.”

In his “day job,” Inwood works as a public information officer with Cook County. He codes computer for fun and, like many civic hackers, is interested in creating ways for people to easily use big piles of government data.

The originators of the site were inspired about the need for nursing-home ratings transparency after a 2014 New York Times story about how the Medicare rating process was possibly being manipulated by nursing homes.

“The story got quite a bit of attention, including in Chicago’s civic tech community,” Inwood wrote on the wesbsite.

Medicare ranks nursing homes based on five factors: Staffing, quality of nurses, state inspection, whether any “deficiencies” have been found and a combined score called “quality measure,” Inwood said in an interview.

The ratings aren’t perfect, but they have been tweaked and improved over the years, he said.

The problem is, only one of those factors is evaluated through a genuine state on-site inspection. The rest are self-reported.

The new website looks at four of the five elements in the Medicare ranking, leaving out the quality measure ranking.

Illinois ranks near the bottom in nursing home quality, according to the Florida not-for-profit advocacy group Families for Better Care.

The website gives Illinois an “F” and ranked the state No. 44 in the country.

One reason for the rotten grade was a poor patient to staff ratio.

“Illinois nursing homes averaged less than 2 hours, 15 minutes of direct resident care per day despite a nominal increase in direct caregiver hours,” the FBC website said in 2014, the latest year it was available.

Illinois nursing homes also reported a higher-than-average number of “deficiencies,” or founded complaints based on health department inspections. In 2014, nearly every Illinois nursing home was written up at least once for at least one deficiency. One quarter of state deficiencies were categorized as “severe” which means a facility may be endanger residents’ safety.

On the site, consumers can see a summary of the most recent deficiency reports as well as whether or not a home has been reported for overmedicating its patients.

The most important score is the “inspection” data, Inwood said, because it’s based on a yearly visit by state regulators to each nursing home.

“You don’t know whether or not the nursing home has a warning or they can just get past the inspections, but every other metric Medicare uses is self-reported,” Inwood said. “The state board of health inspection data comes from an independent authority.”

If you’re searching for a care facility for a family member, Inwood said his site shows how many beds in each site, as well as whether the home is public or private and whether the home accepts Medicaid. The site is a starting place, he said, but can never take the place of a personal visit for research, he said.

“You always want to remember to avoid being blinded by the chandelier effect,” Inwood said, meaning even nursing homes that are well decorated can still perform at the bottom of Medicare’s ranking.

Illinois nursing homes are chronically understaffed, and they are fined for not having minimum staff, Inwood said. “Illinois is particularly bad on staffing. In some cases, it’s cheaper to just pay the penalty than hire someone,” he said.

A study by Pro Publica shows that states with larger fines get results. “If there’s a fine system with teeth in it,” Inwood explained.

“A lot of this is so dependent on the state’s reporting inspections to the federal government and then following through,” he said. In Texas, for example, nursing home fines run around $10,000 for building violations. Meanwhile, in California, agencies that run afoul of the inspectors can be fined $300,000.

“The strength of your deterrence determines the quality of your outputs sometimes,” Inwood said.




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