Judgment day is here again

James M. Berklan
James M. Berklan

When I type at my keyboard, I'm not hoping anyone will come look over my shoulder and scan what I'm doing. Oh, the horrors of possibly discovering ham-fisted typing, missed commas or broken sentences! (All easily corrected after the initial failing, incidentally.)

So I can only imagine what it's like to have your every move and outcome scrutinized. And then have a “report card” issued, one that is published where — literally — the whole world can see it.

But that's your fate, long-term care provider, and I have some bad news: Today it could get worse. Unless you're the star pupil who never gets anything wrong.

Wednesday is the day that U.S. News and World Report publishes its freshened nursing home ratings. Due to new methodology, the number of facilities earning a “Best Nursing Home” rating has been cut 41% this year.

In other words, U.S. News and World Report has taken a page from the Centers for Medicare & Medicaid Services playbook. Remember how the agency recently decided its own grades were trending too rosy for nursing home operators? The solution was to change the criteria so that even if you were deemed pretty good one year and didn't change a thing, you could be taken down a few notches the next round.

U.S. News and others have toyed with ratings and ranking for a while, but it wasn't until CMS unveiled its own Five-Star rating system on behalf of the federal government that they really started to gain traction with the public, Now, everyone — from worried adult children to the biggest investors buying and selling facilities — is paying attention to them. 

Caregivers of the country's most frail and eligible population out there being judged, just like movies, pizzas and beer.

This year, U.S. News gives 2,000-plus nursing homes — 13% overall — its “Best Nursing Homes” label, which some will see as a healthy percentage. This year, to qualify as a Best Nursing Home, facilities had to earn an average of 4.5 stars or better during the 12 months of federal reports ending in October 2016. They also had to consistently meet performance standards set by U.S. News during the period, such as earning at least 4 stars in the CMS overall rating for all 12 months.

The magazine openly tightened its methodology to “give a better sense of how homes perform over time” AND “to determine whether a home provides appropriate rehabilitation services.”

Yes, that spate of high-profile settlements and allegations regarding upcoding and overbilling of therapy services rears its ugly head yet again.

“The changes mean that the designation of Best Nursing Home is given only to those homes that demonstrate consistent performance in national quality measures over a year — versus the [CMS] star ratings, which have the potential to vary widely from month-to-month,” a U.S. News spokeswoman told me, “and to homes that demonstrate appropriate use of key services.”

“Key” in this case is definitely code language for “rehab.” After all, it was U.S. News bloggers who wrote a cutting commentary on “Tying our nursing homes to overuse of rehabilitation” last spring, so it can't be a total surprise that the screws have been tightened.

Overall, the magazine's Nursing Home Finder offers comprehensive information about care, safety, health inspections, staffing and other aspects about more than 15,000 nursing homes. It offers customizable searches for nursing homes by location, distance, Medicare and Medicaid coverage and size.

Millions of eyes peering over your shoulder as you go about your work each day.

It's the price of accepting taxpayer money — in the form of Medicaid and/or Medicare dollars — that allows the continual intrusion and judgment.

It might not be comfortable, but you better get used to it. There will be more scrutiny in the future, just as sure as there will be other hot-button criteria emerging and being factored in. It might just be enough to make these look like the good old days.

Follow James M. Berklan @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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