Medicare Compliance & Reimbursement

Rise and shine: Don't let this latest effort to quantify nursing home quality get you. The Centers for Medicare & Medicaid Services is rolling out a five-star rating system for nursing homes in December, an initiative that could put your facility on or off consumers' shopping lists. And now's the time to find out how the approach will work so that you can explain it to staff and consumers -- and potentially even boost your initial star rating before it's too late. The basics: CMS will calculate a facility's number of stars based on information already reported on the Nursing Home Compare Web site. Specifically, the agency will tap the facility's three most recent years of annual and complaint surveys -- a subset of the 19 quality measures posted on the Nursing Home Compare Web site -- and staffing data, according to the agency's Thomas Hamilton in a lively Open Door Forum on the rating system. These three data sets will be weighted and rolled into an overall quality rating, Hamilton explained. At press time, CMS had yet to disclose its weighting formula or the subset of the QMs used in the rating calculation. Stale Data, Data Manipulation Concerns ODF participants had a few questions during the ODF Q&A session about the star-rating system, including: • How frequently will a facility's posted star rating change? Hamilton noted that overall CMS anticipates updating the five-star rating at least quarterly. And "it's a rolling system" which means that the newer input replaces the oldest information, Hamilton said. • How will CMS audit the information submitted by facilities for accuracy? Hamilton said CMS is looking at that issue and wants to select QMs that are more "resistant" than other QMs to manipulation in a self-reported system. Hamilton also noted that staffing numbers are reported just before the survey process and thus more "amenable" to checking for erroneous reporting. CMS' long-term goal, he said, is to move to more frequent staffing reporting aligned to a facility's payroll system. Potential Dangers, Shortfalls Identified A number of providers and industry experts aired concerns about what they said the rating system doesn't measure -- true quality. A five-star rating system is an excellent idea and would be very helpful to consumers, comments Terry Sullivan, executive director of the Illinois Council on Long Term Care, who expressed his views at the ODF. But, as he told Hamilton during the Q&A session, the system should be based on something more than basic compliance. If a facility has a lot of low-care patients and doesn't take any risks in providing specialty services, you may have a five-star facility that's really a sparse, basic nursing home, Sullivan says. Instead, Sullivan would like [...]