Read Advisory Board's take: 5 strategies for SNFs and their provider partners to ensure high-quality care

U.S. News & World Report on Tuesday released its Best Nursing Homes for 2018-2019 and an updated Nursing Home Finder to help people to conduct customized searches for highly-rated nursing homes.

What's new in the ratings

For the ratings, U.S. News evaluated more than 15,000 Medicare- or Medicaid-certified nursing homes in the United States. Around 3,000 facilities earned a Best Nursing Home designation.

In the past, U.S. News has relied on data from Nursing Home Compare, a website run by CMS, for its Best Nursing Home ratings. However, U.S. News said it changed its methodology after CMS in November 2017 began relying on payroll-based nurse staffing reporting and froze health inspection data. Beginning with this year's ratings, U.S. News said it:

• Changed its overall rating methodology to include a greater emphasis on staffing quality;
• Used staffing data only from April 2018 onward; and
• Applied rating indicators of care that CMS doesn't.

Most nursing homes were given two ratings:

• An overall rating; and
• A new short-stay rehabilitation rating that U.S. News said aims to show the quality of a facility's care for short-stay patients in need of intensive rehabilitation or other nursing services after a surgery, stroke, or other illness.

To be designated a Best Nursing Home, facilities needed to have a High Performing rating in at least one of the two rating categories and could not have a below-average rating in either category.

Where top rated nursing homes are located

According to U.S. News, 2,975 nursing homes were designated a Best Nursing Home for 2018-2019.

U.S. News said Wisconsin had the highest number of top rated nursing homes, with 176 such facilities. The states with the highest proportion of facilities awarded a Best Nursing Home designation were:

• Hawaii;
• Maine;
• Rhode Island; and
• Wyoming.

Brian Kelly, editor and chief content officer for U.S. News, said, "Several million Americans will spend at least some time in a nursing home this year, whether undergoing rehab after a hospital stay or as long-term residents. Finding a nursing home that meets an individual's specific needs can be overwhelming. The Best Nursing Home ratings are designed to help potential residents and their families navigate this important decision" (U.S. News & World Report release, 10/30).

Advisory Board's take

Monica Westhead , Senior Consultant, Post-Acute Care Collaborative

As lists and tools like those put out by U.S. News show, patients and their families are increasingly being given the tools they need to pick SNF providers based on quality. Clearly, clinical quality has always been critical for SNFs. However, this greater transparency, as well as changing payment methodologies that emphasize readmission prevention and outcomes, mean that it's more important than ever to deliver high-quality care and partner with providers who are also committed to clinical excellence.

It isn't always easy to deliver the level of care that today's patients need in post-acute settings, especially as patient acuity and medical complexity continue to rise. All providers—acute and post-acute—need to do their part to ensure that both they are their partners are delivering high-quality care.

In particular, we've found that providers should implement several critical strategies in order to deliver high-quality care. These strategies can help providers weather increasing unpredictability about changes in payment models and episodic accountability. These key strategies include:

• Equipping staff to deliver high-quality care by strengthening frontline staff's core competencies and engaging them in organizational quality goals;
• Strengthening care transitions by formalizing discharge planning and preventing common breakdowns in care transitions;
• Hardwiring access to advanced clinical knowledge by embedding physicians in post-acute roles and using telehealth to gain access to remote support;
• Managing complex patients in the community by leveraging home health partnerships and equipping patients to self-manage; and
• Developing a Cross-Continuum Forum for Ongoing Quality Improvement.

Our Post-Acute Clinical Quality Compendium provides tools, resources, and case studies to implement each of these strategies and address some of the most common challenges to clinical quality. SNFs should use the Compendium to address their own challenges—and hospitals should leverage the examples therein to raise the overall quality bar of their partner post-acute providers.

Improving SNF care delivery doesn't happen in isolation. It requires strong support between acute and post-acute partners. To learn more about why post-acute partnership matters, see our newest infographic.

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