A pall hangs over this sector at the moment, thanks to the New York Times
The self-proclaimed paper of record yesterday pointed out survey-system flaws that can inflate nursing home ratings. For those unfamiliar with the piece, it essentially claims many operators seeking higher 5 Star scores game the system by enhancing the staffing and quality data they submit. While the feds have the authority to audit these numbers, they seldom do.
There’s a saying in baseball circles that goes: If you aren’t cheating, you aren’t trying. Look, I “get” how much pressure there is on operators to get the best possible scores. For some administrators, it can mean the difference between a sweet bonus and a pink slip.
At first blush, it’s easy to accuse the paper of doing yet another hatchet on nursing homes. And I’m guessing that some astute observer will quibble with a minor point or two, and therefore conclude the story is without merit.
Here’s my suggestion: Why don’t we all put on our big-boy pants and accept that the basic premise of the piece is valid. Is it really that hard to believe that many operators desperate for the best possible ratings are goosing the information they control?
Having spent the better part of the last quarter century watching this field, I have come to two troubling conclusions:
The first is that despite rules and many providers’ protests that would seem to suggest otherwise, federal and state regulators really don’t like to watch this field too closely.
Whether due to staffing shortages, insufficient funds, or just plain indifference, the government is largely going through the motions of holding providers accountable. If that were not the case, we would not see stories popping up with maddening regularity that show CMS and its minions routinely fail to carry out routine assignments. Nor would so many shoddy operators still be in business.
My other conclusion is this: There will always be operators who choose to push their luck. This is true in many professions.
This group appears to be in the minority. But to deny that they constitute a sizable chunk of this field is to reject reality. The most egregious members of this less-than-illustrious cohort are those who run yo-yo facilities. They dance on the edge of almost always being put out of business, but seemingly always do just enough at crunch time to earn another chance.
There are also plenty of others out there as well who are not above bending the rules and/or stretching the truth when convenience or incentives make the risk worth taking. Both groups tarnish this field. They are also part of the reason why media outlets find it so easy to find and publish damning stories again and again and again.
Regulators and operators who shirk their duties largely explain why the nursing home field is largely viewed as it is from the outside: as a shady business that’s best avoided. But don’t take my word for it. There are plenty of surveys that support this unpleasant view.
In my younger and more naïve days, I sometimes called upon the industry to start policing itself. I’ve since come to realize that that is sort of like trying to get law enforcement officers to willingly testify against their colleagues. That’s just not the way things work.
So why am I hopeful about the field’s future? Actually, for the same reason that many operators are: technology. Yes, tech tools are being used by providers to expand horizons, improve care and enhance their bottom lines. But technology is also going to be used more often by oversight organizations to do things they can’t do – or now count on nursing homes to deliver. In other words, things like honest staffing levels and accurate quality indicators.
I have no doubt that over time, facilities will no longer be asked to self-report such data, as it will be automated. When that transition occurs, I believe the result will be greater accountability, greater respect for the field, and most important, better care for residents.
Will technology weed out all the bad players in this field? Of course not. But it can help make life more challenging for those who insist on pushing their luck, and a lot better for everyone else.
John O’Connor is McKnight’s Editorial Director.