Stars aligned for shift

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John O'Connor
John O'Connor

The Five Star rating system is about to get retooled, thanks to a scathing report in The New York Times. The only real question is how extensive the changes will be.

In September, the paper of record reported that many nursing homes have been submitting massaged staffing and quality indicator data to the feds. The alleged reason? So facilities could increase their odds of being awarded four or five stars.

And just as fall follows summer, we now have federal lawmakers coming out of the woodwork bearing indignant questions. Just after the Times story broke, Rep. Elijah Cummings (D-MD) sent a prickly letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner.

The gist of the correspondence is that federal regulators, in the immortal words of Ricky Ricardo, have some “‘splainin' to do.” Among other things, Cummings wants CMS to clarify:

• Why the current rating system allows nursing homes of average quality, as determined by government health inspectors, to receive overall ratings of five stars

• The status of CMS efforts to implement the Affordable Care Act provision requiring the use of payroll data to verify the nursing home staffing levels

• The status of CMS efforts to implement an audit program to verify the accuracy of nursing home quality measures 

• Whether CMS has considered the use of a consumer protection hotline or website to receive complaints about nursing homes, in an effort to better inform the rating system

To be sure, questions raised by these issues could pose some dicey challenges. But I have every confidence that CMS will not be throwing itself at the mercy of one House member any time soon. 

You can bet that replies ranging from legitimate answers to plausible deniability are already being field-tested.

Frankly, I'm not terribly interested in how much the designated CMS spokesperson will squirm if or when a confrontation occurs. What concerns me, and should concern anyone who runs a skilled care facility, is this: Then what?