Working the angles as ranking system nears

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James M. Berklan, Editor
James M. Berklan, Editor
If there's one thing I learned long ago as a journalist, it's that the ratings game is a double-edged sword. It doesn't matter if it's a high school football team or a movie you're rating, you will elicit what I call the “Jekyll and Hyde Syndrome.”

If you're No. 1, Grade A or Five-Star, the judges are pretty perceptive, on the money. Miss the top spot or somehow receive an ‘F' grade, however, and, man, what a faulty system you're stuck with.

That's one of the things that makes federal regulators' announcement of a five-star rating system for nursing homes all the more interesting (see page 1). While we shouldn't expect any providers will be turning down four or five stars next to their name, we can definitely expect some squawking about ratings from the nether regions.

Livelihoods and lives could be at stake here. If your college football team gets voted out of a Bowl Championship Series bid by evaluators, it's not liable to go out of business, or put the fate of any of the nation's most frail and elderly citizens in question.

Provider advocates were given a bit of advance notice about the new system announcement June 18 (how else to explain the ready-made press releases?). But make no mistake: No matter how diplomatic their public responses might have sounded, it was not Happy Hour.

Although officials with the Centers or Medicare & Medicaid Services have called for public comment by July 31 and encouraged providers to chime in, you'll notice they did not come on bended knee for providers' input before announcing the new routine.  

We also didn't see association leaders volunteering the nursing home community to take this potentially perilous first step among healthcare providers, as they did six years ago when the Nursing Home Quality Initiative was launched.

 The star rankings are no mere proposal, CMS Acting Administrator Kerry Weems emphasized. This is going to happen, and quick as lightning—by government standards.

Now, the scramble turns to how much of an imprint providers can put on the ranking criteria and algorithms. Promote the tar out of satisfaction surveys, criticize the broken survey system. Those are things they've been doing for years, only now it's in an infinitely more ominous context.

As one insider put it on the eve of the historic new program's unveiling, the devil will indeed be in the details.

So does that mean we'll be seeing more of Jekyll or Hyde? 
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