New survey shows Five-Star rating system’s flaws

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Many providers still are having a tough time embracing the new Five-Star rating system for nursing homes. A new survey shows that their concerns may be valid.

Holleran, a national research and consulting firm, found that there is frequently little or no connection between a nursing home’s rating and resident and family satisfaction.

(Eureka! It’s been proven!)

To be more specific, in an analysis of data from more than 12,000 residents and family members from the primarily not-for-profit sector, Holleran found little to no association between the 1 (“much below average”) through 5 (“much above average”) ratings and satisfaction ratings from residents and family members.

“We did find some similarities between the one and two ratings given by CMS [Centers for Medicare & Medicaid Services], but what the CMS rating system fails to do is accurately capture any clear differences between a two and a three, a three and a four, and so on,” said Lisa Scott Lehman, Holleran’s managing partner.

The study actually found cases where facilities rated a one or two by CMS received extremely high satisfaction scores.

“There is obviously a disconnect somewhere,” Lehman said.

Which gets to exactly why nursing homes have been so skeptical in recent months. It’s been well established that that the survey and certification system is flawed. The field does not believe it is fair to be judged by a system that is susceptible to discretionary judgment, arbitrary rulings and referees with an agenda.

Of course, it’s worth pointing out that Holleran, the company performing these surveys, works for the clients it is surveying. Also of note is that the facilities in this survey are largely not-for-profit settings that belong to larger continuing care retirement communities.

Whether or not this survey fundamentally changes the rating system is somewhat irrelevant. Sometimes there is just something immensely (dare we say?) satisfying in knowing our hunches have been validated.

A move in the right direction?

Ironically, the Holleran survey arrives just as CMS is considering whether to incorporate resident and family satisfaction survey scores into survey results. CMS is meeting with nursing homes today to discuss this possibility. See today’s story for more.

Cross your fingers. All of that grumbling may not have been in vain.
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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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