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in the Kenosha News.

By Jessica Fryman

Nursing home administrators claim it is the federal ranking system that’s to blame for painting facilities in a negative light — including in Kenosha, where half of Medicare-certified nursing homes are deemed below average and well-below average.

By many accounts, the Centers for Medicare and Medicaid Services’ five-star ranking system too heavily relies on health inspection surveys that are “hopelessly broken.”

The ranking system also scores nursing staffing and quality measures as part of its report for consumers.

Last month, Sen. Russ Feingold, D-Wis., introduced a bill in hopes of evaluating the survey’s accuracy and effectiveness in order to possibly find an alternative system and “improve the quality of care in nursing homes and help families make informed decisions.”

While the bill slowly starts its way through the U.S. legislative system, nursing homes are left to defend what may be unwarranted low rankings that don’t refl ect facilities’ qualities.

A broken system
The newly introduced bill, Improving the Quality of Care in Nursing Homes Act, focuses on the health inspection survey portion, which nursing home offi cials say drags down the effectiveness of the entire CMS five-star ranking system.

The surveys measure hiring practices, staff policies, resident rights, pharmacy services and the overall nursing home environment but have been called unfair and inconsistent.

“No. 1, the problem is (the five-star ranking) weighs too much on the survey process because the survey process itself is hopelessly broken,” said Brian Purtell, director of legal services of the Wisconsin Health Care Association.

To some, the system is “beyond repair” because it’s “complicated, inconsistent and ineffective” and doesn’t take improvements or mission statements into account, according to a 2008 report from the American Association of Homes and Services for the Aging.

“Providers found themselves, year after year, embodied in negative and adversarial encounters with surveyors who seemed bent on ‘fi nding something wrong,’” the 95-page AAHSA report said.

Since most of the overall rating depends on the health inspection surveys from the last three years, there is little emphasis on quality measures. Some experts call quality measures the most important aspect of care because it is about actual outcomes, such as percentages of patients who have bed sores, who have been restrained or who have become more depressed or anxious.

Scoring a 1 (much below average) or 5 (much above average) in quality measures is the only way the category affects a facility’s overall ranking.

Kenosha facilities
That discrepancy — scoring low overall despite being ranked above average on quality measures — is common in Kenosha. Two of the three facilities that scored a 1 overall marked a 4 in quality measures.

Sheridan Medical Complex faced a similar circumstance earlier this year. The facility had 4’s in both nursing staffi ng and quality measures, but still ranked “below average” with a 2 overall because of its 1 in the survey portion.

“Nobody has outscored us in quality measures and nursing staff,” said Debbie Bathke, the facility’s executive director. “We do a very good job with the outcomes.”

This month, the facility raised its overall score to average when its most recent health inspection survey showed improvement and scored a 2.

Another major complaint with the system is the lack of patient feedback. For example, although Hospitality Nursing and Rehabilitation Center received a 1 overall, 81 percent of families expressed overall satisfaction with the center’s care, according to an independent satisfaction survey by My InnerView.

Glimpses of value
Despite its flaws, some say the five-star system gives consumers a starting point for information on facilities.

“While the five-star system has some use despite its failings, you have to go visit, ask informed questions and tour a facility,” Purtell, of WHCA, said. “It’s a decent starting point for people to begin the discussion, but this does not tell the whole picture.”

Purtell said consumers can use the information provided through the CMS five-star ranking reports
to ask more specific questions when visiting nursing homes, including requesting an explanation of any citations the facility might have.

St. Joseph’s Home for the Aged administrator Mary Emmanuel said she thinks the five-star ranking is effective but nothing replaces face-to-face interaction with a facility’s staff. She suggested consumers take a tour at different times throughout the day and look for the level of residents’ activity and cleanliness.

This story was originally published in the Kenosha News
on June 28, 2010.

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Sidebar: What the ranking system means

The Centers for Medicare and Medicaid Systems ranks nursing homes on a five-star system in three categories: health inspections, nursing home staffing and quality measures. Here’s how it works.

What the stars mean
5 = much above average
4 = above average
3 = average
2 = below average
1 = much below average

A 5 is awarded to nursing homes scoring in the top 10 percent, a 1 to the bottom 20 percent and 2’s, 3’s and 4’s are evenly distributed among the remaining 70 percent of scores. Health inspection Known as the survey portion of the rating, health inspections are conducted annually on average. Surveys are done in a six-month window to ensure the visits are unexpected.

Surveys are an overview of patient care, interaction between staff and patients and nursing home environment.

Nursing homes that are cited for immediate jeopardy instances, where a noncompliance has caused
or is likely to have caused serious injury, impairments or death to a resident, can dramatically bring down a facility’s ranking.

Inspections from the last three years are included in the current star count, with the more recent years having more weight. The data is compared statewide.

Nursing home staffing
This information is self-reported by nursing homes, and gathered by surveyors at each annual
health inspection. The rating includes overall staffing hours for medical professionals.

The number of staff hours per resident per day is used to calculate the rating. The data is compared
nationally.

Quality measures
This information is also self-reported by nursing homes. The information comes from data routinely collected on residents at specifi ed times. For example, the percentage of patients with bed sores, those who have been restrained or who have become more depressed or anxious are calculated for this ranking. Rankings are calculated based on national comparisons.

Overall score
The overall ranking starts out at the number of stars a facility receives on the health inspection portion.

If a facility receives a 5 or 1 on quality measures, the overall score will go up or down one star. A 4 or 5 in
staff ratings will bump up the overall score by one as well. This calculation puts the majority of the weight on health inspections when calculating the overall ranking.