Five-star fiasco

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What do nursing homes want for Christmas? Something that they are unlikely to receive: a new five-star rating system.

The Centers for Medicare & Medicaid Services presented them with a most unwelcome holiday present on Thursday with the unveiling of a rating system that could end up doing more harm than good for the reputation of the nursing home industry.

The system, which relies on inspection reports, staffing data and quality measures, has some glaring problems, such as its reliance on an inconsistent survey process. Nursing home associations are also concerned that the criteria used to calculate the rating for staffing does not accurately reflect the number of caregivers in facilities.

What seems most worrisome, however, is the overly simplistic nature of the system. Just as we make snap judgments about hotels, restaurants and other consumer-oriented industries, the same is now likely to happen with nursing homes.

A daughter looking for a nursing home for her mother could overlook a decent facility—without even looking at it—because of its rating posted on the Nursing Home Compare Web site,

“While we support having a quality rating system we don’t believe this five-star system is accurate, nor does it achieve the goal of providing a better tool for consumers,” Susan Feeney, spokeswoman for the American Health Care Association, told me.

Providers’ concerns are warranted. Judging healthcare is not the same as judging a penthouse suite or a seafood entrée. And it should reflect the complex nature of these services.

For information on the rating system, go to

First impressions

Yesterday I mentioned how disappointed the American Association of Homes and Services for the Aging was in CMS’s handling of the ratings out of the gate. AHCA feels the same way.

“We are both very disappointed in this program [and the way it was rolled out],” Feeney noted.

CMS apparently preferred to release the database of rankings to the national media and state surveyors before nursing homes—or even the associations—received the rankings. Feeney said the association was contacted when nursing homes were reached by the press for comments on ratings they didn’t yet have.

Asked if she had received all the data, Feeney responded, “We do now, through USA Today.”

The newspaper, which received the ratings early from government sources, got to number crunching quickly, and has released statistics about the findings.

Facilities are now concerned with inaccuracies in the data and the timeliness of the data presented.

The rollout of the five-star system somewhat reminds of the mistakes made with the release of the list of “Special Focus Facilities.” If you can recall, CMS last November released to the general public only the names of 54 facilities out of a total of about 128.

Consumer advocates complained that lobbyists and associations received the full list, while most of the country did not. The roles seem to have been reversed in the latest scenario, with nursing homes being excluded from the process.

It’s a shame that initiatives that should be used to help improve quality end up fostering resentment.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.