The Five-Star Quality Rating System was introduced for US nursing homes in 2008 and is designed to help residents and their families compare homes based on three measures – health inspections, staffing and quality measures (QMs).

A new study has found while higher-rated facilities had lower hospital admissions before the system came in, the rates of preventable hospitalisations for two to five-star rated facilities were higher after its release.

The researchers say that it’s possible providers have been ‘teaching to the test” and making superficial changes that don’t actually stick. Another explanation is that providers are “cherry-picking” patients that skew their ratings.

“It is possible that for-profit nursing homes with higher 5-star ratings were incentivized to select high-risk patients (by partnering with hospitals willing to share their readmission incentives, for example). Selection of lower risk patients by poorly rated facilities would also explain the decrease in hospitalization rates among 1-star facilities after 5-star release.”

A reminder that five stars doesn’t always guarantee better care.