James M. Berklan

There is hope. That is one key takeaway from the American Health Care Association annual meeting in Orlando this week.

There is hope that AHCA and the Centers for Medicare & Medicaid Services can work well together. How do we know this? The technology worked. 

Yes, the video hook-up between a CMS official who was forced to deliver his educational presentation from Baltimore to not one, but two overflow rooms of eager AHCA listeners in Orlando went off without a hitch. Even the Q&A session at the end, mediated by AHCA Vice President for Quality Affairs David Gifford, M.D., in Orlando worked as planned.

As an “outpost” victim of all too many blurred, interrupted or simply never functional audio-visual hook-ups, I can promise you this is no small feat and should be treasured.

Now about that other small matter of the messages delivered … did I mention the video hook-up was nearly flawless?

CMS nursing home official Evan Shulman was once again providers’ steadfast link to their most important regulatory agency. In typical fashion, he generously covered a handful of important topics. But the one he led off with and the one that dominated the Q&A segment was clearly the reason for the standing room-only crowds.

Unfortunately, Shulman was given the lousy task of trying to sell the rationale behind the icon chosen as a consumer “warning” label on the Nursing Home Compare website for facilities cited for certain abuse deficiencies.

An outward-facing open-palm means “stop” with traffic cops, basketball referees and airport security lines, and it certainly did to the crowd listening to Tuesday’s presentation, and countless others. But to CMS folk, it does not.

Several times Shulman earnestly asserted that the logo, which was first introduced for this purpose last week, does not mean stop or do not proceed. He might as well have been telling the AHCA viewers the things they were sitting on weren’t really chairs. 

Why not use a red or yellow question mark? I heard from viewers who didn’t laugh or scoff. Or a yellow exclamation point. Another high-up official simply shrugged and said, “If it walks like a duck and talks like a duck … “

CMS will be in contact with stakeholders leading up to the Oct. 23 implementation date, Shulman promised the viewers. It didn’t necessarily convey a tone that said they should expect a different icon, but we’ll see. Shulman has always been remarkable for his approachability, something I’ve seen providers quickly realize and appreciate time after time. 

Shulman also reminded the crowd that “more than 95%” of providers would not have the icon affixed. Encouragingly, he also intimated that surveyors should moderately weigh potential D citations so that quickly-forgotten resident-on-resident jostling, for example, does not thrust providers into icon erritory. (Everyone acknowledged that getting state surveyors to uniformly help with this would be difficult, but it was a positive verbal exchange nonetheless.)

In addition, he said that the controversial symbol has been used for the same purpose in other places and that it would be accompanied by instructions to Nursing Home Compare visitors to ask questions of facilities with it, not automatically bypass them.

I asked CMS for clarification on these points Wednesday and a representative said he was tracking down the information, which might not be available until Thursday. Fair enough. Clarity, after all, is the root of all of this. If you have to explain a joke, as the saying goes, it’s not so good. The same thing goes for icons.

Please check back in this space for updates. We’ll promptly post whatever we find out.

There is often fear of the unknown, and anxiety about the new. Successful precedent for something like using this icon could help soothe. And if the icon — despite the universal message it seems to give — comes with explicit instructions to ask questions of a tagged facility and not speed by it, that could ease some tension. Besides, as Shulman rightfully pointed out, there are some very concerning places with disturbing stories of abuse that need as much light as possible cast upon them.

In the meantime, I can’t help but think about a saying my favorite fifth-grade teacher used with pupils who were destined for stints as fast-talking teenagers: Don’t hand me an apple and tell me it’s a banana.

Follow Executive Editor James M. Berklan @JimBerklan.