A new study published in the journal BMJ Quality and Safety has revealed that Yelp reviewers give nursing homes significantly less favourable ratings than those found on the federal website, Nursing Home Compare, run by the Centres for Medicare and Medicaid Services.

Both the Nursing Home Compare website and the popular online business rating site, Yelp, feature five-star rating systems to help consumers evaluate nursing homes. The study showed that a nursing home's Yelp rating differed from the Nursing Home Compare rating more than 75% of the time, and it was significantly lower in three of four categories reviewed.

Consumers have reported difficulty with understanding Nursing Home Compare ratings. This is problematic because earlier study indicated that some nursing homes listed on the federal website are gaming their ratings. Nursing Home Compare rolled out its five-star rating system in 2009 using data from nursing home inspections, staffing reports and resident assessments.

The overall rating combines scores from three areas: health inspections, staffing levels and quality measures. Health inspections were the only category that rated significantly higher when compared to the Yelp star ratings. Yelp boasts 145 million first-person word-of-mouth reviews of business and service providers.

The reviews generally describe a consumer's personal experience with the provider. Previous research in hospitals shows that Yelp reviewers tend to focus on subjective experiences of health care, such as a reviewer's personal assessment of staff attitudes, the physical setting or the cost of care.

The study results highlight the need for further research to improve and strengthen the rating systems used by nursing home consumers. Both Nursing Home Compare and Yelp have faced charges of artificially manipulated ratings. Previous research estimated that faked reviews and ratings on Yelp range from 16% to 40%.

However, the researchers said that since gamed Yelp ratings may encompass either or both extremes of the 5-star rating scale, this bi-directional practice, coupled with increasingly savvy consumers and Yelp's efforts to weed out fake reviews, likely cancels out their ability to impact ratings.

Recent reviews of the Nursing Home Compare system concluded that the rating system provides a financial incentive for gaming and that the practice of nursing homes reporting purposefully inflated data continues, despite modifications designed to discourage it.

The study findings might shed light on why the Nursing Home Compare ratings are mostly higher than the Yelp ones. Future studies would aim to analyze the content of Yelp reviews and compare the themes and topics consumers identify to those reported by CMS.