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New Nursing Home 'Star’ Rankings May Cloud the Big Picture

12.05.2008

Star ratings have made it easier for consumers to compare everything from crash test ratings for new cars to fancy restaurants. As early as this month, people shopping for nursing home care will have the same “at a glance” perspective when Medicare launches its new online five-star rating system.

The idea, according to the Centers for Medicare and Medicaid Services (CMS), is to give consumers an easy, short hand way to compare data on the quality of care and other measures at nursing homes locally, regionally and nationally. 

The need is real: More than 1.5 million people live in the 15,000 U.S. nursing homes. But experts warn that the system could actually cause more confusion when trying to find the right facility for a patient’s particular needs, increase the risk of lawsuits against nursing homes and unfairly disadvantage facilities that care for the most frail patients.

“Today, more than 19 different quality measures are reported on Medicare’s ‘Nursing Home Compare’ web site but the star system will include only a subset,” said attorney Mark Kopson, a partner with the law firm of Plunkett Cooney in Bloomfield Hills, Mich., and head of the firm’s healthcare industry practice.

“One risk is that consumers might not consider a very good facility because they didn’t investigate it thoroughly. That could lead to facilities refusing to accept high-risk patients. No one will want to risk losing a star in their overall rating.”

Kopson said that facilities that treat patients who need the most intensive care, including stroke victims, those with dementia and people with potentially debilitating conditions like advanced diabetes, may offer excellent care but score low on the star system because their residents are inherently more prone to pressure sores, urinary tract infections and other common – and often unavoidable – complications of nursing home care.

“If Medicare and private insurers were to reduce reimbursements to facilities that don’t earn the highest scores, there probably would be even fewer facilities willing to accept the neediest patients,” he added.

The risks don’t end there, he said. “It’s easy for consumers – and potentially jurors – to misinterpret or take out of context data that’s incomplete. And that’s exactly what the star system is: a well-intentioned but potentially superficial analysis of the quality of care.”

Kopson’s advice to families searching for nursing home care is to look deeper than the star system when evaluating a facility. “Fundamentally, you need to be confident that the facility’s doctors and nurses can develop and implement a care plan that addresses the individual physical and mental needs of the patient.”

For nursing home operators, he advises them to be diligent in monitoring the data reported on Medicare’s web sites for errors. But it’s even more important to communicate clearly and candidly with families and prospective residents.

“Caring for the elderly and the infirm is one of the most challenging fields in healthcare,” Kopson said. “Understanding the facts about aging, the care and treatment options that different facilities offer and the full story behind the surveys and rankings is in everyone’s best interest.”

Established in 1913, Plunkett Cooney employs more than 150 attorneys in nine Michigan cities; Columbus, Ohio and Indianapolis, Indiana. The firm has achieved the highest rating (AV) awarded by Martindale-Hubbell, a leading, international directory of law firms and has received several awards naming the firm a top place to work in the legal industry.

To view Medicare's Nursing Home Compare web site, click here.

For more information about the federal government's star rating system, contact Plunkett Cooney's Practice Development Manager John Cornwell at (248) 901-4008.

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