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Attorneys general recommend Five-Star overhaul

October 1, 2009
by Bob Gatty
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As nursing home interests in Washington continue to battle proposed Medicare cuts to help finance healthcare reform, they also have tackled another issue: the five-star nursing home rating system launched by the Centers for Medicare & Medicaid Services (CMS).

In late August, the American Health Care Association (AHCA) welcomed an August 20 request by 31 state attorneys general that the Five-Star Quality Rating System be temporarily suspended until it can be revised to compare individual nursing homes against a national standard rather than on a state-by-state basis. The state AGs said the current system makes it impossible to evaluate nursing homes across state lines and can be misleading and confusing to consumers.

CMS has been working to expand the rating system over the past year, building upon the Nursing Home Compare system that was initially launched to help consumers decide which nursing home would best serve their families' needs.

Under the new system, a rating of one to five stars is given to nursing homes within three separate categories-health inspections, quality measures, and staffing levels. Through Nursing Home Compare, consumers can check alternatives to nursing home care and follow specific steps that are recommended in making a nursing home selection.

But the state AGs who are concerned about whether the five-star system is misleading, sent a letter August 20 to Secretary of Health and Human Services Secretary Kathleen Sebelius urging that the five-star system be suspended until it can be revised.

“We strongly support a nationwide criterion-referenced evaluation methodology for establishing proficiency at all levels for nursing homes as opposed to the normative state-by-state methodology presently utilized by CMS,” the letter said. “The correct and appropriate criterion-referenced evaluation methodology would gauge the success or failure of a given nursing home by an absolute national standard.

“In the interest of consumers as well as providers, we believe it imperative that the current Five-Star System be suspended temporarily and revised using a more appropriate criterion-referenced evaluation methodology,” the letter said, noting that the Nursing Home Compare system would still be available to consumers “during what should be a short revision process.”

In a news release, AHCA President and CEO Bruce Yarwood said the long-term care community appreciates the effort “to provide consumers an accurate representation of the care our profession provides every day for millions of frail, elderly, and disabled individuals.

“The fact that these 31 state leaders, who are dedicated to protecting consumers, came together to highlight weaknesses of the current Five-Star System speaks volumes about the weaknesses in a system that was developed to aid consumers,” said Yarwood. “We join these attorneys general in urging Secretary Sebelius to re-evaluate CMS' scoring and ratings criteria to ensure that appropriate information that truly reflects the quality of nursing home care is available for all consumers.”

Signing the letter to Sebelius were the attorneys general of Alabama, Alaska, California, Colorado, Connecticut, Florida, Georgia, Guam, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, and Wyoming.

Meanwhile, nursing home organizations continued to object to proposals contained in healthcare reform legislation advanced in the House of Representatives that would slash $32 billion from Medicare for nursing home care.

Yarwood, in mid-August, issued a statement saying that seniors hoping to gain insight into the health reform debate were being distracted by “extremist and inaccurate rhetoric” from healthcare reform opponents, distracting them to the “real threat” posed by the proposed cuts in the House bill.

“We encourage public officials and citizens alike to focus on policy ideas, not negative sound bits that scare seniors and obscure the facts,” he said. The proposed cuts would be in addition to $12 billion in reductions imposed in July by CMS.

“These cuts are too deep, not sustainable, and beyond placing seniors' quality of care at risk, would force caregiver layoffs and job cuts at a time Congress and the Obama administration are attempting to stem the tide on rising state and national unemployment rates,” he said. “These enormous Medicare cuts, which will place upwards of 50,000 key jobs in jeopardy, make no sense on a health or economic policy basis.”

AHCA released a national survey by the Mellman Group, which finds that Americans by significant margins strongly oppose those cuts over other funding options. According to the poll, 66% of voters would be less likely to support their local member of Congress for reelection if they voted to cut seniors' Medicare-funded care to finance health reform.

In its analysis of the survey results, the Mellman Group said most Americans believe such cuts would reduce the quality of care seniors receive in nursing homes, as 78% of those over 65 said they believe nursing home care would get worse and 58% said it would get “much worse.”

Thus, as lawmakers move toward a final compromise healthcare reform plan in Congress this fall, they will have the results of the Mellman Group survey to consider.