The BIG Picture: five-star survey system to the rescue?

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John O'Connor, Editorial Director
John O'Connor, Editorial Director
Want to raise a colleague's blood pressure? Just casually mention the government's five-star rating system.

It won't be long before you hear about how unfair it is to nursing homes. You should also brace for complaints about arbitrary ratings based on skewed data. You're also likely to get an earful about inconsistencies in the way surveyors are trained—not to mention their bizarre preferences and prejudices.

By the way, these are all legitimate concerns. In fact, I was pretty much in the same camp. But then author Malcolm Gladwell helped change my mind. Gladwell writes for The New Yorker magazine, and his latest best-selling book, What the Dog Saw: And Other Adventures, is a collection of 19 of his more memorable essays.

One of these works, “Million Dollar Murray,” is about a Denver homeless man beloved by ambulance drivers and police alike. But Murray, despite his lovable attributes, is a mess of a man. Questionable choices have rendered him a homeless alcoholic. But not just any homeless alcoholic. He's a very expensive one, at least when it comes to post-bender cleanups. By one estimate, he racked up more than a million dollars in ambulance and hospital costs in less than a decade.

Gladwell uses this example to make a larger point: Sometimes it's easier to fix a problem (in this case, homelessness) than it is to manage it.

And when you think about it, survey and certification requirements have largely been the government's way of managing bad nursing homes. They are the backbone of a fractured oversight system that allows really dreadful places to yo-yo in and out of compliance.  

The reality is that regulators are loathe to shut down a bad facility, as it creates a boatload of new placement and oversight challenges. Nor has it been in the industry's best interest to self-police.

And therein lies the beauty of the five-star system. By pointing out facilities that merit only one star, regulators are letting customers and anyone else who cares to know who the really bad players are. Yes, there is the risk that a not-so-bad facility could receive a one-star ranking. However, these facilities, on average, are cited for 14 deficiencies. So let's get real.

As AAHSA's Larry Minnix likes to say, there will be two kinds of nursing homes in the future: the good and the non-existent. For all its flaws, the five-star system will help bring that day closer.
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