A note from SNFs to hospitals: Stay away from Misfit Island

John O'Connor
John O'Connor

Despite heated protests, the Obama administration just announced it will move ahead with plans to give hospital operators the Five-Star ratings treatment.

That means about 3,600 acute-care facilities will soon be receiving new scores, based on escalating star designations.

Toughen up hospitals, it's not going to be the end of the world (at least, not for most of you). But if the experience of skilled nursing homes is any indication, many of you will soon have legitimate reasons to be upset.

Skilled care operators have had to endure the five-star system since 2008, so it might be fair to ask why it took so long for hospitals to be included. The answer appears to be that your army of lobbyists did a masterful job of holding off the seemingly inevitable for almost a decade. That is quite an accomplishment.

But as Mama used to say, you can fight gravity for only so long. Your sector's efforts to prohibit ratings were doomed for a simple reason: Consumers and regulators like them.

When the Centers for Medicare & Medicaid Services initiated nursing home ratings, regulators predicted the change would “provide nursing home residents and their families with a mechanism to assess nursing home quality, enabling them to make distinctions between low and high performing nursing homes.” Essentially, that same logic is now being applied to you.

If it's any consolation, a five-star system will not be the sector's ruination. Still, many hospitals and health systems will not be pleased. For unlike the mythical children of Lake Wobegon, all hospitals will not be above average.

FYI, here is how skilled care operators are generally reacting to their new grading system:

•  The five-star facilities are thrilled. They are like the students who received an A-plus on the big test.

•  Even most of the four-star facilities are feeling pretty good about themselves. After all, they are “above the curve,” which makes them suitable candidates for hospital discharges and contracts with managed care companies. Plus, it puts them in pretty good stead with state regulators, who generally prefer turning the screws on established underachievers.

•  The three-star recipients present more of a mixed bag. Nobody's genuinely happy to be in this category, especially operators who have been recently downgraded. But like a bronze medalist, at least they are on the proverbial podium. Plus, they avoided the dreaded two- or (heaven forbid!) one-star rating.

•  As for those one- and two-star facilities? Remember the “Rudolf the Red-Nosed Reindeer” holiday special? Let's just say these operators can relate to the residents on the Island of Misfit Toys. They feel generally unwanted and are viewed as deeply flawed.

So here's some sophisticated advice for hospitals entering the Brave New World of five-star ratings: Try to get the most stars possible. Good scores will help in every way — perhaps most of all with parties who are predicting that they won't be such a big deal. Everyone seems to warm up to the easy-to-grasp 1-to-5 rating style.

While Misfit Island may have its charms, you really don't want to end up there.

close

Next Article in Daily Editors' Notes

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

    ALL MCKNIGHT'S BLOGS