And so the day came when some 5% of nursing homes in the country were branded with their own “Scarlet Letter.” The letter, of course, was in the form of an open-palmed “stop” icon in a red circle.
Those marked with this dramatic symbol would be the ones who were cited for abuse causing actual harm in the last year or an instance of abuse potentially causing harm over each of the past two years.
They had little more than two weeks’ notice that this brand of shame would be coming, and the provider community complained loudly about both the propriety and the mixed message of the icon itself. This writer led the chorus on the latter point.
So what did we learn Oct. 23 when the curtain rose on this unnecessarily dramatic sideshow? Two things. Beyond the absence of humility to admit that the particular icon chosen was inappropriate — or at least was inappropriately unveiled without a better visual example — we learned that the Centers for Medicare & Medicaid Services has taken some pains to explain what it is trying to do.
The icon appears after the facility’s name and is not at the very start of the entry, which keeps it out of speed-skimming territory.
There is also a prominent explanation on the Nursing Home Compare website search page, which does a credible job of explaining what consumers should do if they’re interested in a facility that bears this icon.
Interestingly, right below that explanation is the exclamation-point icon in a yellow triangle that signifies the even rarer, poorer-performing members of the Special Focus Facility group.
It seems part of CMS’s problem might be that it was already using the icon it should be employing for the abuse “warning.” Let’s review the rules of the road: Yellow means warning. Red, on the other hand, means stop and take a long look.
Facilities that receive two D’s in two years — for any of a variety of reasons, many of them subjective — could be looking at the ominous red icon online for a year.
Overall, the verdict seems to be: CMS made a decision, and since the agency is your lifeline, you have to suck it up and deal with it.
There actually might be two more lessons learned. One, if federal regulators decide they want to do something to get your attention, they have numerous powerful ways to do it and they’re clearly not afraid to use them first and ask questions later.
The other? If you think you’re being wronged, in the long run it’s better to raise your voice and be ignored by unapologetic bureaucrats than to be strong-armed and shamed in sullen silence.