The Fault In Their Stars…

CMS' fuzzy, Five Star math means that providers have to do the accounting for "low" quality.

CMS’ fuzzy, Five Star math means that providers have to do the accounting for “low” quality.


Hello, ProviderNation. Sorry to distract from the week’s most important event in history, but the fine folks at Kaiser have crunched the numbers, done the math, and added it all up. And they’re not happy. According to Kaiser’s analysis, nearly two out of every five skilled nursing center is lowly rated under the gummit’s Five Star Quality rating system.

Kaiser admits that another 45 percent of the nation’s centers have Four- or Five-Star ratings, but also finds that:

  • For-profit centers tend to have lower scores than nonprofit centers;
  • Smaller centers tend to have higher ratings than bigger centers;
  • Self-reported measures tend to be higher than measures “derived from state inspections;”
  • In 11 states, 40 percent of the centers tend to have low ratings, while in 22 other states (including the poor, benighted District of Columbia), at least 50 percent of the centers have four- or five-star ratings; and
  • States where the proportion of poor elders is higher tend to have lower-rated centers than states with more prosperous elders.

The Big Public, no doubt, will want to get into crash position. The problem, of course, is that it was my understanding that there would be no math here at the debates. (Excuse me again, my fellow Americans.)

You’ll recall that, earlier this year, the fine folks at CMS rebased their Five-Star system. By the stroke of a pen, nearly one in three of the nation’s care centers saw their quality rating fall, without quality actually falling. At the time, provider advocates worried that the CMS decision would make it even harder to tell hawk from handsaw; now, to their chagrin, they find themselves answering pointed questions that, to their way of thinking, is already more than a little question-begging.

“We worried about the Five-Star changes creating confusion, and now, unfortunately, it appears as though we were correct,” says Tom Coble, an Oklahoma provider and board vice chair of the American Health Care Association.

Gore Vidal, famously, said that “the four most beautiful words in common language” are “I told you so.” (The three most depressing words, Vidal added, were Joyce Carol Oates.) But something tells me that Coble and his friends take cold comfort from being right all along. Still, Coble tells me he’s trying to stay positive.

“Even so,” he says of the Five-Star debacle, “we’re proud that over half of all centers continue to be ranked at four stars or higher. What’s important, though, is the continuing commitment to quality care. We will never stop in that pursuit.”

Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.

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