Ready or not, here come the federal star ratings

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James M. Berklan, Editor
James M. Berklan, Editor
The era of the venerated five-star nursing home could be just around the corner. Then again, it might not.

That's because nobody really knows if there will be any five-star rated facilities when the Centers for Medicare & Medicaid Services unveils its new ranking system next month.

Perhaps this is good news for anxiety-ridden nursing home operators: You might not be five-star, but then again neither will any of your competitors.  But one thing is abundantly clear as of this writing: The star-rating system used so famously for everything from Harry Potter movies to steakhouses will soon be in action for nursing homes, too.

Dec. 18 was the forecast day it would be unveiled on the CMS's Nursing Home Compare Web site (

CMS officials are hell-bent on getting it up and running as an early Christmas present to consumers—and themselves. Many at CMS are political appointees and nobody's sure who will remain after inauguration day. So that means it's time to try to put a few more stamps on personal legacies.

For Acting CMS Administrator Kerry Weems, the time is now—not in the future—and he's riding this hard. Weems and crew see this initiative as another opportunity to show how quality-focused they've been.

Since the five-star program was announced last summer, there have been few changes in criteria for the grading system. Quality scores, federal survey and certification data, state survey results—all subjective markers, in operators' estimation—and self-reported staffing data are the pillars.

At least the staffing numbers will get some sort of case-mix consideration. Also, ratings will be differentiated by state, and rightly so.

But the fact remains that CMS is building this five-star system's house on the sandy foundation that is the troubled survey and certification system. The feds are simply attaching more value to subjective, flawed information, as providers are willing to remind anyone who will listen. Furthermore, blending resident and staff satisfaction survey results into the ratings formula was taken off the table, along with numerous other judging points. They've been relegated to “Phase Two” consideration, according to regulators. The big problem with that is nobody knows when a Phase Two will start, if ever.

Given all the problems a new administration will have to deal with, nursing home operators do not figure they will be at the top of anyone's “To Do” list. And that's a sure way to get a low rating in anyone's book.

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