Steven Littlehale

Recently my colleague Ken Kelley, MS, OTR/L, RAC-CT, a clinical consultant/reimbursement specialist, posited something about Five-Star ratings that I hadn’t considered. 

He suggested that, in general, consumers would more likely Google a nursing home and read the customer reviews than navigate to CMS’ Care Compare. In our industry, we’re so accustomed to tracking our official star ratings that I suspect we’d likely go to the source, but what about the lay community? Is Ken right — and does it matter?

If we think Ken is right and Google rules, should skilled nursing facilities be more focused on managing their social media presence versus their Five-Star rating? They are not the same thing. Times are hard and resources are in short supply. So, which do you prioritize? Which do you think is more important for attracting patients/residents and even staff?

Over the last two weeks, I asked over 200 nursing home operators/providers whether social media presence or Five-Star rating was more important, and unanimously they responded “Five-Star.” Why? They agreed that Five-Star influenced their occupancy and directly impacted their financial outcomes. Here is a sampling of what they shared: 

  • “True, families ultimately make the decision, but they are steered by the hospital to nursing homes in their network. The hospital builds their network with Five-Star.”
  • “Drop below a three-star rating and the phone starts ringing and my inbox fills up. Corporate, lenders and managed care want explanations. A bad Google review needs to be managed, but that doesn’t impact us as much.”
  • “If I was below a three-star rating, it would put loans in jeopardy and cut off referral streams.”
  • “I agree that the public generally doesn’t go to CMS for Five-Star, but other easier-to-use sites pull their data from CMS. It’s the same Five-Star information, maybe with a little spin.”

Many operators shared candidly that you cannot focus on just one or the other. Many facilities have a dedicated person assigned to managing their social media presence, often marketing/business development, and that includes reviews. Managing online reviews wasn’t an afterthought, here is what they shared:

  • “Our team was too shy to ask family for a review, so we used signs throughout the center and also role-modeled for them to build their confidence in soliciting feedback. It really helped.”
  • “Most people only post when they are angry or frustrated. Frequently asking for feedback improves our service and reviews. I ask residents and family daily, ‘How are we doing?’ ‘How can we do better?’ whenever I see them.”
  • “We had a competitor post a negative review about us. We worked with Google to confirm and remove the rating. That’s got to be part of the process as well.” 
  • “Our DON and administrator are accountable for our Five-Star rating, but our business development team proactively solicits our patients and families to share their experiences online through social media.”

The empirical literature offers some insight into which rating you should care most about. In one small study in Maryland, investigators found that consumer ratings from four social networking sites correlated with and predicted CMS star ratings. This suggests that if residents/families are happy, you likely are delivering a good clinical product and possess competent staff, and surveyors will confirm this quality during annual recertification. That seems like a leap of faith, but let’s not dismiss the idea entirely. 

Another study found that Five-Star’s quality measures don’t always align with what consumers value in nursing home care. This interesting study, worthy of replicating, reminds us that we cannot solely rely on Five-Star scores to evaluate our customers’ satisfaction. 

I was asked recently if we should resist or embrace CMS’ proposal to include resident satisfaction in our public reporting. My response: “Open those arms wide and run toward it.” 

Bringing the consumer voice more directly into the evaluation of nursing home care and outcomes will only make us better.

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.