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Heads Up-CyberRatings Are Here

March 1, 2001
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Interview with Robert N. Bua, CEO, CareScout.com
AN INTERVIEW WITH ROBERT N. BUA Thanks to the growth of the Internet, consumers today can find out just about anything they want to know-and that includes information about nursing homes and other long-term care facilities. Web sites that rate nursing homes for consumers are springing up on the Web, joining HCFA's Nursing Home Compare site www.medicare.gov/NHCompare/Home.asp in helping to keep the public informed. Nursing Homes/Long Term Care Management Managing Editor Linda Zinn asked Robert N. Bua, founder and CEO of one of these ratings sites and author of The Inside Guide to America's Nursing Homes (Time Warner, 1997), to tell our readers how his service works and what nursing home operators and administrators should know (and do) about what's being said about their facilities online. Bua's Web site, CareScout.com, provides ratings of nursing homes and home healthcare agencies, and information about assisted living facilities and hospice care providers. Zinn: How long has CareScout.com been up and running, and how has it been received so far?

Bua: CareScout.com was established in May 2000, but the research and proprietary data it provides came from efforts begun in 1997 with the founding of National Eldercare Referral Systems and in 1999 with our first Web site, NursingHomeReports.com. Since CareScout was launched, our traffic and membership have continued to grow, and our business relationships expose our ratings to an audience of 30 million people. Among the members who have relied upon our products and services are such diverse entities as CNN, General Electric, Consumer's Digest and Harvard University.

Zinn: Some have expressed concerns about the accuracy of your ratings and other information that appears on CareScout.com. From what sources do you derive that information, and how do you verify its accuracy?

Bua: CareScout's proprietary ratings are based primarily on a facility's current and historical performance on HCFA survey inspections, along with compliance records and JCAHO data. These data and the research we use for our objective ratings are accurate and reliable, collected directly from HCFA and private sources. For example, we do not use the data posted on HCFA's Web site, but rather we use raw data obtained directly from that agency. CareScout's tedious testing and quality measures verify and reinforce data integrity. Our ratings are based on the most uniform, most consistent nursing home audit process available in the nation today. Now, is HCFA's system perfect and free from inconsistencies? No-like any system, it isn't. But it is nonetheless the best available, and its data are valuable. As is stated in the "How to Use CareScout's Ratings" section on our Web site, people using our service should not base their decisions on a single rating. A facility might rank highly in its historical rating but have a poor current rating or a negative quality-of-care trend. We urge CareScout users to question why quality of care might be dropping-for example, because of a change in ownership or major staff change. I think those who doubt our ratings are really doubting the survey process. They are questioning the government's ability to enforce standards in a consistent way. That is a fight to be fought with HCFA, not with us. We, too, seek continuous improvement in the survey process, because we all win with a better system. We are the messenger, relaying the results in the most accurate way possible. It's a classic case of "Don't shoot the messenger."

Zinn: You mentioned historical survey performance ratings. How far back do you go in compiling survey data?

Bua: We review the four most recent survey inspection results. Those reading the nursing home ratings should keep in mind, though, that while a facility's historical performance is important, it is also essential to know what its recent performance has been. That's why we have multiple ratings indicators for each facility: We paint as fair and well-rounded a picture as possible.

Zinn: What specific aspects of a nursing home do you examine to make your assessment?

Bua: We view facilities from four angles. First, our objective ratings use the eyes and ears of state surveyors who interview residents and families, inspect medical charts, monitor meals, view hands-on care and observe resident rights and dignity issues. This is some of the information used to develop the CareScout ratings and rankings. Second, our FieldScout evaluations are based upon the experiences of a local care manager or other qualified health professional familiar with the facility but not a member of its staff. Third, consumers relate their subjective opinions about a facility. And fourth, administrators and owners complete provider forms, on which they may describe services, add marketing language and state why their facility should be considered. I should point out that FieldScout, consumer and provider feedback does not influence the CareScout ratings.

Zinn:What qualifies someone to become a FieldScout, and how many are associated with CareScout.com?