James M. Berklan

The Liistro family has been involved in long-term care for longer than many readers of this blog have been alive. When you get to 50 years, you need to keep counting.

They’ve been very good years for the most part, but the latest round of regulatory goalpost-shifting has the company CEO banging his head in frustration. In short, one of his buildings has become the poster child for being caught in the latest round of Five-Star Nursing Home Quality Ratings adjustments.

Now, Paul Liistro has been put in the uncomfortable and atypical role of playing defense. His Vernon Manor Health Care Center in Vernon, CT, has been put on a “watch list” by the local hospital — its major referral source. In addition, its “preferred provider” status with an accountable care organization is in jeopardy.

And always there is the pressure from managed care groups and their take-it-or-leave-it contracts. It’s a particularly ugly situation for any provider that has lost stars and, therefore, bargaining leverage.

Liistro traces the predicament to an unexpected drop in Vernon’s Five-Star rating.

The culprit, he says, was the Centers for Medicare & Medicaid Services’s reversion in April to using three previous survey scores, not just two, to calculate ratings. A disgruntled employee left the company three years ago bad experience three years ago after and incited surveyors to file an 88-citation report. It created havoc that is still “haunting” Vernon, Liistro notes.

Compounded the problem is Vernon came up 38 hours of RN staffing short in a recent measuring period. This ran afoul of CMS’s new, lower threshold for allowable time without an RN on duty in a given month.

The ripple effects, which include mandated scoring drops, now put Vernon at an overall 2-star rating. This is for a facility with nothing lower than a 4 — seven 5’s and four 4’s — over its last 11 rating periods. And it has a 91% approval rating from residents to boot.

“All sticks and no carrots,” is how Liistro explained it in a note to local caregivers, trying to explain that the bottom has not fallen out of one of their best business partners.

It’s put Liistro and his team in a peculiar position: They can’t wait for surveyors to stop by again. In fact, they have let it be known that their doors are wide open any time inspectors might want to stop by.

Until that happens, however, they have to bide their time. Even when a good follow-up survey might occur, there will still be lag time before it would be officially recognized via new ratings.

It’s maddening to Liistro, a well-known figure locally and an active leader in national professional circles. He’s been an American Health Care Association board member, a fellow with the American College of Health Care Administrators and much more. I first met him years ago when he was a panel member for a high-level McKnight’s round table discussion.

“I’m no Joey Bag of Donuts — everybody in Hartford knows me,” he says proudly. “Vernon was one of the 27 percent of facilities that got more money in the value-based programming. Going back three years falls into the ‘Who cares?’ category. If they went back two years for a golfer or a car racer, they’d say, ‘Who cares?'”

Comparing readmission rates would make more sense, and Vernon has excelled there. “We’re remarkably lower than the national average,” Liistro says. “We’ve knocked the cover off the ball,” he proudly said, making a baseball reference.

But it doesn’t matter much now, Liistro fears. He longs for the old days when business and contracts were earned face-to-face, not necessarily by prescribed formula or algorithm.

“This is actually happening and the ‘Stepford Wives’ reaction — by networks, hospitals, ACOs — is stunning,” he said, referring to a novel and movie that features submissive spouses who do everything by formula. “A star rating drops and no one cares. You are either on probation or out of the network. And this is in a local market where my family has been for over 50 years and everyone knows the quality we have provided. ACOs are so attuned to Five-Star, and they have no idea how it is determined.”

Chalk it up to the school of unintended consequences. That much is evident with what is happening at Vernon Manor.

The changes have created confusion among potential residents and their families, and that helps no one.

It’s a consequence predicted long ago in this space: Once you give people something as simple as a star rating to latch onto, they’re not going to dig deeper to understand nuances behind it.

Follow Editor James M. Berklan @JimBerklan.