Editor's desk: Stars losing their luster for 'punished' providers

James Berklan
James Berklan

One gets the feeling that federal regulators, no matter how proper the official talk went, took a bit of pleasure in sending a message to providers when recently rebasing their star ratings.

It began with a “courtesy” call to providers, where officials explained nursing homes' values were going to be undercut — in a week.

A possible mess to explain to residents, family members, board members, the general public and anybody they might be trying to make a positive caregiving alliance with? Oh, well.

Then, they publicly announce “an expanded and strengthened” nursing quality rating system that brings “improvements.” Not so prominent is the fact that nursing homes' star ratings were cut overnight simply due to administrative decisions. There's not necessarily a drop in quality performance despite the markdowns. (And, hey, did we mention how courteous they were about letting you know a week ahead of time?)

According to industry and media calculations, more than 30% of nursing homes were expected to have lost a star in their overall Five Star rating. Most also took a hit on quality numbers, just by waking up.

The Centers for Medicare & Medicaid Services clearly employs many insightful people, including some who have worked directly with nursing homes. Couldn't one of them have produced some prominent form of communication that says, “Hey, we're basically starting everybody over on this star-rating thing, and we're also adding a few more measures that we think will make all of this more accurate, anyway”? It's an idea. 

To be fair, the 21st line of the fact sheet CMS put out concedes: “However, the changes in the quality measures star ratings released in February do not necessarily indicate a change in the quality of care provided.” 

By taking the “We're toughening up things” stance, CMS set the tone. Eventually, it gave a few complimentary pats on the head to providers, but the overall implication was: Thanks for doing your job, but something's amiss.

There is bound to be friction between government regulators and those they regulate. But let's get this tweaking process right. Prod continual improvement but stop moving the goalposts. Add criteria, but keep the framing the same, so everybody in the game or watching from the sidelines can keep perspective.

To do otherwise would be, well, less than courteous.

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