Minnix: CMS administrator vacancy delaying possible Five-Star rating system changes

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Fourth annual McKnight's Online Expo: Six days to go
Fourth annual McKnight's Online Expo: Six days to go
The absence of a chief at the helm of the Centers for Medicare & Medicaid Services may be stymieing providers' attempts to persuade federal regulators to modify the new Five-Star Quality Rating System for nursing homes, a prominent provider advocate said this week.

CMS' director of survey and certification, Thomas Hamilton, said he is "not likely to change anything" until a new administrator is in place. That is according to Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging. Minnix spoke to McKnight's at his group's annual spring conference and exhibition in Washington. The conference ends today.
"I hope they will have a real quality-improvement, healthcare person in that job," Minnix said. "It will all be about system change. That doesn't need to be another politician. There needs to be an expert in that job. Mark McClellan [the former CMS administrator under George W. Bush, and a physician] was the gold standard as far as I'm concerned. There have been two or three people mentioned that would be good."
Minnix expressed hope that Gov. Kathleen Sebelius (D-KS), President Obama's nominee for secretary of the Department of Health and Human Services, would be confirmed soon so she could then nominate a new CMS chief. Charlene Frizzera became CMS' acting administrator after Bush left office earlier this year.
The Five-Star system "is still a hot topic. It is unjust, inadequate and poorly designed, with flawed data," Minnix said. "That hasn't changed. What has changed is, [providers] are doing their part to make sure that data's going in clean. We're trying to eliminate the 'garbage in, garbage out,' but it's still garbage coming out."
Minnix said providers met with CMS officials and requested a handful of changes to the rating system. They included forming work-study groups to improve each of the three ratings sub-categories (survey results, quality indicators and staffing).

Providers also want a consumer satisfaction element factored in. "We also want a change from the bell-curve shaped system, where in any given quarter, only 10% to 12% of facilities can be five stars," he noted. "You could be a five-star facility, do nothing different (less) and be three stars the next quarter."
He also found fault with the Five-Star system because it could lead to facilities concentrating on courting "five-star residents," at the exclusion of more complicated, higher-acuity residents. To the irritation of provider advocates, the Five-Star rating system has grown in acceptance and as a point of reference among consumer groups and the mainstream press since debuting last December.