Heads Up-CyberRatings Are Here

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?

Bua: These are people to whom consumers typically turn for help with eldercare decisions, such as care managers, nurses and social workers. Their experience complements CareScout’s objective information by providing a trusted and valued perspective that only someone with firsthand knowledge can offer. We carefully screen all applicants’ licensure and work experience. Our minimum requirement, in addition to licensure, is that they have at least two years of experience as a healthcare professional for the elderly. We have more than 80 FieldScouts in place now.

Zinn:Once the site was in operation, did you find you needed to make any adjustments in how you gathered or dispersed information about long-term care facilities?

Bua: Yes, we have made changes over time, such as incorporating scope and severity factors into the ratings and improving the usability of our reports. We recognized early on the need to develop technology to allow not only consumers but also administrators, owners and employees to share information and provide feedback about their facilities. It’s important to point out that we allocate as many resources to enable providers to list their marketing information on CareScout as we do for our Community Review module. CareScout certainly does not take an adversarial approach to long-term care providers. In fact, our aim is that our efforts will improve the state of the industry, help facilities with their marketing efforts and, consequently, improve the industry’s reputation.

Zinn:Earlier you mentioned factoring in the scope and severity of survey deficiencies in determining your ratings. Could you elaborate on that a bit?

Bua: We recognize that some violations are for purely administrative functions, while others relate more closely to hands-on care. Obviously, the former shortcomings have less impact on a facility’s ranking than the latter.

Zinn: There’s an objection long-term care facility operators and administrators might have to your rating system: It must be impossible to track every improvement or decline in quality of care for the 58,845 nursing facilities, assisted living residences, home healthcare agencies and providers of hospice care that CareScout monitors. How would you respond to that?

Bua: It’s true that late-breaking news is not generally reflected in our ratings, but we do update them on a quarterly basis. The impossibility of keeping track of every development, good or bad, is what makes our historical ratings so invaluable. A short-term blip does not drastically change whether a facility has consistently over- or underperformed its peers. For those who need the very latest information, current county and state ratings will reflect the most recent performance. Current state ratings are available when you conduct a search on CareScout.com. The current county rank is found in our in-depth “Nursing Home Reports,” which we provide for a modest fee. The rapid changes that occur in the quality of long-term care were the reason behind our investing in technology that empowers administrators, consumers and FieldScouts to update the provider areas of CareScout daily, to complement CareScout’s objective ratings. We encourage providers to take advantage of the technology platform we’ve built for the purpose of communicating their messages to America. There is no cost to long-term care facility operators for submitting their marketing materials and facility information to appear alongside the reviews and ratings.

Zinn: If someone disagrees with a rating or comment about their facility on the CareScout site, what can that person do?

Bua: Our Provider Feedback form can be used to state any information the administrator or owner wishes to display to complement the CareScout information. If there is an error in factual information, they should contact us, but if someone is not happy with a facility’s rating that accurately reflects its survey performance, the best way to improve the rating is to improve the performance.

Zinn: How else can operators and administrators use the information found on CareScout.com to help them in marketing their LTC facilities?

Bua: I’d like to re-emphasize that providers really should take advantage of our site by posting information about themselves on CareScout.com. One good example of a facility that uses this option well is Victoria Haven, in Norwood, Mass. Also, I’ve seen our ratings popping up everywhere lately. I know of at least one nursing home that describes its CareScout ratings on its voicemail system, while a caller is on hold. Nursing home administrators also display their personalized CareScout Quality of Care Ratings Certificates.

Zinn: Is there anything else you’d like to tell our readers about your service?

Bua: As a licensed nursing home administrator with experience overseeing a 300-bed skilled nursing facility, I am certainly sympathetic to the challenges long-term care facilities face. I’m not out to create scapegoats but to help improve the industry and the public’s perception of it. With all the negative press long-term care has been receiving in the past couple years, anything we can do to improve the quality of care is going to help the entire long-term care industry in the long run.One caveat I include on the Web site is for people not to use it as the sole basis for choosing a home for their loved ones. CareScout.com is a good jumping-off place. It allows users to focus on the best facilities in a geographical area and eliminate the poorly performing ones, but it doesn’t replace a personal visit-perhaps along with the advice of a trusted friend or pastor or social worker who is personally acquainted with a particular facility. For each facility rated, we list the specific services that are offered and provide information on staffing and other features that can help people narrow down their search, using a technology called SmartMatch. They simply choose a geographical area and select characteristics they’re looking for in a facility, such as specialized Alzheimer’s care, number of beds, etc. Having done that, they have the simplified task of visiting a handful of nursing homes, rather than dozens, before making their decision. In the final analysis, nothing replaces seeing a facility for oneself. NH

For further information, phone (781) 431-7033, fax (781) 431-7034 or visit www.carescout.com

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