No joke: Nursing Home Compare, ratings earn praise

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James M. Berklan
James M. Berklan

At first blush, the phrasing seemed like the punch line to a questionable long-term care-related gag. But upon further reflection, it began to sound more and more like an earnest compliment. The government's Nursing Home Compare website is better than others but still ripe for improvement? So true.

First, it's appropriate to address the naysayers who have been against this consumer “transparency tool” from the start. Quite a few providers took umbrage when nursing homes were volunteered to be the first healthcare providers rated like new movies playing at the cinema or restaurants opening down the street.

Five stars? Or is that Five Spoons? Or maybe Five Smiley Faces? Healthcare is not some cheap commodity that one rates like Saturday night entertainment options, critics railed (and still rail, to some degree).

And they're right. But, as many other realists predicted, the Five Star ratings have become like an invasive plant in the yard: Here to stay and you better figure out how to make the best of it. Everyone from consumers to insurers to venture capitalists now refer to the Five Star ratings without a second thought.

While the Centers for Medicare & Medicaid Services might not deserve an Oscar for its performance rolling them out, the ratings systems have started to do their intended job. The good news, depending on your point of view, is that Nursing Home Compare is more advanced overall than the four other transparency tools the General Accountability Office recently studied.

That's partly because it had such a head start on the others. It seems like just yesterday that then-CMS Administrator Tom Scully was calling nursing home association chiefs Larry Minnix and Chip Roadman two of the bravest guys he knew (for being the first guinea pigs in the government's ratings strategy). But Nursing Home Compare was launched back in 1998, with a full unveiling to the public about five years later.

Launch dates for Dialysis Facility Compare (2001), Home Health Compare (2005), Hospital Compare (2005) and Physician Compare (2010) ambled onto the scene, conveniently after much smoke had cleared from nursing homes' tiptoe onto the minefield. Some of the rollouts have been more drawn out than others.

Three tools — Hospice Quality Reporting, Inpatient Rehabilitation Facility (IRF) Quality Reporting and Long-term Acute Care Hospital Quality Reporting — are still “under development.”

The new GAO analysis (“Health Cost and Quality Transparency”) finds Nursing Home Compare on par or better than the others in all but one category: “describe[s] key differences in patient experiences.” Only the hospital and home-health models get a “yes” here.

Among plaudits given to Nursing Home Compare is that it is the only model that "summarizes related information and organizes data to highlight patterns.”

“Unlike the other Compare sites, according to CMS officials, Nursing Home Compare does provide the ability to sort providers by performance according to the star ratings on several summary measures covering inspections, staffing, quality measures, and the facility's overall rating,” report authors add.

So what do the report's findings mean for nursing homes? Among other things, regulators are going to be trying to pin down cost and value differences better. They acknowledge variables will make this a tough thing to do, but providers have to remember these tools are devised with the consumer needs in mind, not operators'. It is a point emphasized by GAO authors in their report, which could lead to less input from providers in the future.

Regulators also endeavor to recast Nursing Home Compare and the other sites in more understandable language. Good luck with that one. If there is anything government agencies are not well known for, it is eliminating acronyms and gobbledygook. Then again, let a few U.S. Senators' families have problems with any of the sites, and you might see just how quickly they'll get cleaned up into common English. Four Senators (Coburn, Klobuchar, Shaheen, Toomey) requested the GAO report but you can be sure that interest doesn't end with them.

The report indicates a few things authors didn't necessarily put down in black-and-white. One, there simply is no argument any more whether the Five Star ratings and Nursing Home Compare are valid tools that will be around in the future. The discussion clearly has moved from “Are they suitable or should they be eliminated?” to “How do we keep improving them?”

Another is that poor providers are being increasingly penned into a corner. Nursing Home Compare and the Five Star ratings have always been about the good celebrating their successes and the bad and marginal cowering while waiting for possible negative fallout. Sometimes it has come, sometimes it hasn't.

This has always been the case, most famously illustrated by the initial publishing of ratings in large U.S. newspapers around the country 10 years ago. As providers waited for their world to cave in with all the extra staffing and performance information in the public's hands, what really happened was … virtually nothing. The information was too dense and too voluminous for consumers to make sense of or act on.

Slowly, however, the public and various institutions have adopted wider use of Five Star and Nursing Home Compare. In addition, regulators have sharpened their information gathering skills, and targets. Early next year, for example, more caregiving categories will feed into the ratings formula, and providers will lose the ability to self-report on some of the judging criteria.

As Minnix and Roadman, the leaders of what is now LeadingAge and the American Health Care Association, conceded long ago, it's going to be better to accept the following: Greater transparency is going to be the demand moving forward — by both regulators and the public.

Rather than fighting the notion, it's going to be better for providers to accept it and work with their inquisitors, instead of fighting the wave or hoping it just fades away.

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

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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