John O'Connor, editorial director, McKnight's Long-Term Care News
John O’Connor, editorial director, McKnight’s Long-Term Care News

All sides generally agree that the current nursing home survey system is flawed. But there’s hardly consensus on how best to fix it.

In many ways, our nation actually has 50 survey systems. That’s because each state’s health department is responsible for inspecting nursing facilities within its borders. As a practical matter, that means that inspectors’ training can vary greatly. One result is that discoveries that will get an operator in deep trouble in one state may not even be noticed in another – and vice versa. But to look at the Five Star Ratings System created by the Centers for Medicare & Medicaid Services, you’d think the judging is identical. It’s not.

At a time of dwindling state resources, consider how much money goes into this oftentimes wasteful and always expensive kabuki dance.

But Chicago aldermen working on a different issue may have stumbled upon a better idea. The City Council is developing a “self-certification” plan that would let food retailers with a clean record police themselves — and forward inspection reports. Grocery stores, gas stations and other low-risk stores that mostly sell pre-packaged foods and beverages would be eligible. Restaurants also could participate, provided they have not been closed for food safety issues in the preceding three years.

The idea here is to free compliant business owners from bureaucratic entanglements with inspectors. The ordinance also would let inspectors focus more on establishments where problems are likely to occur.

The city council example is not a template. But the approach is worth considering.

Imagine if CMS were to let good operators essentially police themselves, with the caveat that inspectors would pounce if or when trouble occurs. One clear benefit of such a shift is that surveyors could focus more on the bad apples that keep spoiling the barrel. It also would put less of a burden on states to hire inspectors. Such a shift also would give most operators a strong incentive to stay as trouble-free as possible.

Sounds like a dramatic improvement over the way things now work. But it would require federal and state regulators to reconsider the way things get done. In other words, it’ll happen right about the same time pigs harness unaided flight.