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 AHCA Board Chair Sees 'Very Big Educational Challenge' In Five-Star Flap

The Obama administration finds itself under attack from a fellow Democrat after questions were raised about how the government measures the quality of care in the nation’s nursing homes.
 
In a letter to the Centers for Medicare & Medicaid Services (CMS), U.S. Rep. Elijah Cummings (D-Md.) says he has “serious concerns” that providers “have been gaming” CMS’ Five-Star Quality rating system.
 
Cummings was relying on a published report in Monday’s New York Times, which purported to show that federal regulators were over-reliant on self-reported statistics from providers in awarding stars under its quality measurement system. The report cited a California rehabilitation center, which was awarded five stars despite complaints from advocacy groups about the way the center was run.
 
It’s unclear how much impact Cummings’ letter will have: He is the ranking member of the House Oversight and Government Reform Committee and a reliable ally of the administration, but his party is predicted to remain in the minority in the House and may well lose its majority in the Senate. The president, meanwhile, has been beset by crises from Ferguson, Mo., to Syria.
 
Still, the controversy is a message to providers about their “very big educational challenge,” says Leonard Russ, principal of Bayberry Health Care and chairman of the American Health Care Association (AHCA) Board of Governors.
 
“I’ve always felt that reducing the complexity of something like health-care providing … to a rating system that you might find for a restaurant or a movie is an oversimplification,” Russ says. “But we’ve tried to work within the system to try to improve it. We’ve always felt that no consumer should look at the Five-Star system as the be-all, end-all of quality measurement.”
 
Ironically, it was providers themselves who balked when CMS proposed a Five-Star rating system in the early part of the century. Since then, however, groups such as AHCA have pressed their members to embrace the system and build a more constructive, less adversarial approach with regulators and policymakers. The approach has largely worked—helping prevent drastic cuts to the sector, for instance—but for Russ and others, the profession is still vulnerable to “suspicion, innuendo, and hearsay.”
 
“The New York Times story, for example, concluded that providers are ‘gaming’ the system simply because not every piece of information reported to the government is independently validated.  Yet the article did not offer factual evidence that providers were systematically furnishing exaggerated or misleading information. In fact, Medicare routinely conducts in-depth audits to validate the information facilities provide to justify their payments.   
 
“StilI, I think it there is a much larger issue at work here when it comes to nursing facility placement,” he tells Provider. “I think it’s ingrained in our culture, our fears about getting old. It’s about what happens to people when they get old and require that level of care. You can’t look at this from 30,000 feet and make sweeping generalizations.”
 
AHCA and its sister group, the National Center for Assisted Living, have spent decades refining their own quality measures—many of which have found their way into federal law or regulations. Russ says he himself has seen how much improvement the sector has made in delivering quality care to the nation’s most vulnerable, often under very challenging and unpredictable payment streams.
 
If nothing else, this week’s controversy should underline his original point that statistics—however they’re measured—are no substitute for careful consumer research.
 
“A decision as complex and personal, and even, sometimes, as painful as whether to place a loved one in a long term—or even short-term—facility can’t be reduced to a snapshot set of numbers,” he says.
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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