As rating system changes, nursing homes should power on

James M. Berklan
James M. Berklan

As the countdown to Friday begins, and nursing homes ratchet up their anxiety over the public debut of the “new” Five Star rating system, I have a few words of wisdom to share.

Breathe deep and carry on.

Odds are “Discovery Friday” will not mean as much to the public as you fear. Certainly not initially. For one, it is very unlikely that there will be hordes before your doors, yet alone any of them brandishing printouts, wondering why your ranking switched from, say, five stars to four, or four to three, overnight.

By now, you have had a chance to view and digest how your rating might be changing during this rebasing of the standards. That should help. Remember at the Centers for Medicare & Medicaid Services Open Door Forum last week how your regulatory leaders said they were graciously giving you a “courtesy” viewing of your new rating numbers?

Yes, at times, they seemed to stammer and audibly whispered among themselves while determining what answer to give. And, OK, their overall sales pitch of the changes left a lot to be desired. Especially given the fact that they knew ahead of time what a touchy subject this would be. 

But, hey, it's time to pick up the pieces and move on.

CMS is supplying providers with a fact sheet of some sort to share with residents, family members and the rest of the public. My suggestion is to use it to create your own flyer, highlighting the parts that say this is just a one-time adjustment that ALL providers are subject to. In fact, it would be pretty noble of regulators if they created a few simple flyers themselves, legitimized with an impressive CMS signature or two. They're changing the rules, so the least they could do is highlight that providers who have lost a star didn't necessarily get busted doing something wrong, and state here's why. Again, putting this explanatory info out there in a simple manner.

But, providers, if they don't do it to your liking, what better opportunity is there for your eager marketing department to show it can make a difference? Get out ahead of this. Frame the issue the way YOU want it.

The big problem, as an official with the nation's largest nursing home provider association so eloquently put it, is this: CMS has moved the goalposts.

This should not be the end of the world. It's inconvenient, yes, but as long as this is not a regular occurrence, the provider community should weather it OK.

There is precedent for high government officials acknowledging that a bell curve for handing out nursing home star ratings is inappropriate. Not long after the star ratings were introduced — and nursing homes were the first sector to be subject to them, in 2008, remember — I had a chance to ask the Secretary of the Department of Health and Human Services if any adjustments to the new system would be in order. Seated at a table of media and other officials at the 2010 American Society on Aging conference, then-HHS Secretary Kathleen Sebelius responded quickly and reflexively: No, she said. There should not necessarily be “X” percent of nursing homes automatically tagged with a one-star label, nor at the two-star, five-star or any other level. To paraphrase, she said her department would have to take a look at reforming the process and readjust “inherent flaws” as needed.

Provider associations saw her comments and highlighted them as prominently and as often as they could. Whether it was a toothpick or a stick of dynamite in the ratings system wall, nobody can say for sure, but change came. Sebelius since has left office and a significant amount of time has passed. Regulators, for whatever reason, now seem to think they have ceded too much ground. 

Ultimately, it's their game, and their ball. Sometimes rules do change. What's critically important is to keep reminding everyone just who it is that has “moved the goal posts.” The fact is, providers, you are undoubtedly getting boxed in even tighter than before. The bar is being raised.

Now, it's time to be resilient and build back up. Just like you did the first time the ratings came out. (Notably, there was no popular public backlash at the time.)

You will get over this. You have to. And then cross your fingers that the goalposts aren't moved again.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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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.

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