You had to know this was coming.

Earlier this week, the New York Times reported that many nursing homes are submitting massaged staffing and quality indicator data to the feds. The alleged reason? So facilities could pull better Five Star ratings.

And just as fall follows summer, we now have federal lawmakers coming out of the woodwork bearing indignant questions. Just one day after the Times story broke, Rep. Elijah Cummings (D-MD) sent a prickly letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner.

The gist of the correspondence is that federal regulators, in the immortal words of Ricky Ricardo, have some “’splainin’” to do. Among other things, he wants CMS to clarify:

• Why the current rating system allows nursing homes of average quality, as determined by government health inspectors, to receive overall ratings of five stars

• The status of CMS efforts to implement the ACA provision requiring the use of payroll data to verify the nursing home staffing levels.

• The status of CMS efforts to implement an audit program to verify the accuracy of nursing home quality measures? What other metrics are being considered

• Whether CMS has considered the use of a consumer protection hotline or website to receive complaints about nursing homes, in an effort to better inform the rating system.

To be sure, those questions could pose some dicey challenges. But I have every confidence that CMS will not be throwing itself at the mercy of one House member any time soon. You can bet that replies ranging from legitimate answers to plausible deniability are already being field tested.

Frankly, I’m not terribly interested in how much the designated CMS spokesperson will squirm if/when the upcoming confrontation occurs. What concerns me, and should concern anyone who runs a skilled care facility, is this: then what?

We could just see a day or two of embarrassing news coverage, followed by proposed legislation that quietly dies in committee. If that’s the case, no real biggie.

But what if something far more severe plays out? Like an executive order, or even a new federal law that revamps the entire process? Should those scenarios occur, the survey and certification system that we now know would become a thing of the past.

Could things actually get to that point? Right now, it’s far too early to tell. But as the ALS bucket challenge has shown us, once something new and different gains traction, you just never know where the fun will end.

Or who’s going to end up all wet.


John O’Connor is McKnight’s Editorial Director.