This is not the article an industry hack should write

This is not the article an industry hack should write but . . . I fundamentally believe the revision of the 5-star system for skilled nursing facilities is a move in the right direction. I would acknowledge that, perhaps, it could have been done in a more artful way, but, nonetheless, it was the right thing to do. 

As I see it. . .

  • The whole rating system has become more of a video game where the players work to get the highest score using whatever methods it takes to get there. Here is the evidence: Prior to rescoring, 80% of all skilled nursing facilities had an overall rating of 4 or 5 stars. While I could not find the exact number, one website reported that more than 50% of all skilled nursing facilities had a 5 star rating.
  • This is not just a game to win. It is about frail vulnerable elders who need great care and fantastic outcomes. In some cases, fantastic outcomes may mean rehabilitation and returning home; in other cases, it might mean dying with great dignity and comfort.
  • The 5-star rating should really mean something. It should only go to SNFs that are providing exceptional care and are having way above average outcomes. It should not be something that is ever achievable by 50% of the skilled nursing facilities. If more than 50% of all hotels are 5-star hotels, we’d think that system is broken and needs to be fixed.
  • If you operate a true 5-star community, you should be celebrating this  recalibration. You should be recognized as being an outstanding community that is way above your peers, not lumped in with other communities that played the game well.  
  • This should be a call to providers, publications, and trade associations to get better. 
  • It should be a call to demand reforms to a system that has devolved into a documentation nightmare, that distracts from providing quality care. 
  • It should be a call to demand adequate reimbursement.  
  • One publication suggested this move was unfair because it would be like having a kid think he was getting As on his report card one day, only to be told the next day he was really getting Bs or Cs. A fair enough analogy, but do we really want kids who are doing B or C work to have report cards that say they are getting As?  I would hope not.
  • Because it has been so relatively easy to get a 5-star rating for many communities, it has resulted in a ceiling on the quality of care.  After all, if I have a 5 star rating . . . the best rating, why should I try any harder? In fact, it might even lead one to conclude that it is impossible to get any better.

I am not unsympathetic to those facilities that have lost a star or more. I know it can have real and significant economic consequences for those facilities, and yet here we are. I would suggest that those communities use this change as an opportunity, as motivation, to get even better.

Steve Moran