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Federal regulators are meeting with nursing home operators and other key stakeholders today to discuss ways in which resident and family satisfaction surveys might be factored into the new facility Five-Star Quality Rating System.

The conferees also will be examining a possible new way to depict surveyor (inspector) ratings, staffing levels and quality measures for providers with high levels of short-stay residents.

Regulators have considered three possible levels of use for satisfaction surveys, noted Thomas Hamilton of the Centers for Medicare & Medicaid Services during a special CMS “Open Door Forum” conference call Thursday. Providers have strongly called for satisfaction surveys to be added since before the controversial Five-Star system was rushed into place in December.

Hamilton said the three levels are not mutually exclusive and could be phased in. They could involve 1) simply noting whether a facility uses satisfaction surveys, 2) developing a system to judge the merits of such surveys, and 3) developing a national survey that would be “objectively measured by a third party.”

Also among the “complex” issues being considered today, Hamilton said, would be whether or not surveyor ratings should be expressed in hard numeric terms, as many providers desire, rather than the percentile rankings now used. He added that there was “general agreement that a preferable way” of reporting staffing levels would be a quarterly system based on payroll records, rather than just self-reported data from a two-week period centered on survey times about once a year. Regulators also want to explore if facilities with more short-term residents should be compared only against similar facilities, rather than a larger class of nursing homes, Hamilton said.

Hamilton told the 555 forum participants that his agency fielded an average of 94 calls a day from providers in December. That number dropped to 38 in January and then 18 per day in March before rising to 24 daily in April, which is when quarterly quality measures data was updated for the first time. A similar spike is expected after this month’s new figures are posted, he said. (See Most questions have pertained to staffing data, he noted.