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 AHCA Chief Cautions on Effects of New Nursing Home Compare Reviews

Since the Centers for Medicare & Medicaid Services (CMS) made changes to the Nursing Home Compare website last October to have a red stop sign warning icon placed on reviews of facilities cited for one of three standards of abuse and neglect, the intention of the move may have been lost, according to an column authored by Mark Parkinson, president and chief executive officer of the American Health Care Association/National Center for Assisted Living.

“On its face this may seem like a straightforward method to convey information to the public. However, a closer examination reveals that rather than improving transparency, this new icon may lead to greater confusion and uncertainty,” he said in the opinion piece for The Hill.

Parkinson cites real-world examples that would result in the new icon being displayed. One example involves missing food. “A resident of a dementia care facility was storing guacamole in a communal refrigerator. It went missing. As this is classified as ‘misappropriation of property,’ the facility is obligated to report this to the state authorities, and it could result in an abuse citation,” he said.

Another example involves two residents leaving their facility’s dining room at the same time in wheelchairs. In doing this, they bumped into each other. Neither resident was injured, but this too resulted in an abuse citation.

“Regardless of the overall quality of care at these two facilities, both could be subject to the new alert icon on the Nursing Home Compare website. Facilities that receive the new icon also have their Five-Star Ratings capped at two stars, which will mask information from other important quality concerns that impact this rating,” Parkinson said.

This action is inconsistent with the stated goal of CMS to help “consumers develop a more complete understanding of a facility’s quality.” The symbol could lead people to avoid a facility altogether based on incomplete information, he said.

Instead of the way the icon is being deployed now, Parkinson said there are better ways to increase transparency that would be less prone to mislead consumers. “For instance, using an icon that indicates the need for closer examination—such as a yellow triangle with an exclamation point—instead of outright avoidance, would be more appropriate,” he said.

In addition, CMS should add customer satisfaction to the Nursing Home Compare website, because that is the best way for consumers to select facilities. While nearly all other health care sectors, including acute-care hospitals, have a CMS reporting requirement on satisfaction, skilled nursing does not. Making this information available to future residents and their families will go a long way toward enhancing transparency, Parkinson said.

“Ultimately, the most surefire way of ensuring transparency is for those choosing a nursing center for themselves or a loved one to make visits to facilities in their area. There they can ask questions about the specific services provided; ask questions of staff, other families, and residents; and learn about payment options,” he said.

Finally, Parkinson said as the skilled nursing profession and all stakeholders work to increase transparency and eliminate any instances of abuse and neglect, it is vital “that we do so in a way that makes information easier to understand for the people we serve. Misleading, ambiguous information is a step in the wrong direction.”

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