Susie leaves the doctor’s office with a handful of glossy brochures. They all feature smiling faces, yet she is apprehensive. It’s time to choose a skilled nursing facility so she’ll be in the right place following her upcoming hip replacement.
At 79 years old, Susie wants to recuperate in a center with satisfied patients, kind staff, and a reasonably high medical standard.
She enlists the help of Michelle, 30 years her junior, who is good at navigating the great big Web. They easily locate the Nursing Home Compare website her doctor had mentioned. Together, they narrow the search down to her desired location (near the grandkids, of course!), and peruse the star rating near each facility.
Only two facilities remain on the screen. SpringHill Skilled Nursing, with a four star overall rating, and ANF Nursing and Rehab, boasting a neglectful single-star rating.
With a four star overall rating, SpringHill it will be!
The building’s exterior photos look pleasant enough, if a bit outdated. Greenery surrounds the entrance, and the woman sitting outside is accompanied by a cheerful-looking aide.
“Susie, you’ll love this place!” says Michelle. “Look, they’ve even earned five stars in Staffing Levels!”
The laptop is snapped shut. The decision is made.
They are not aware of the fact that SpringHill Skilled Nursing is comfortably seated on the Federal Enforcement System’s SFF (Special Focus Facilities) list for over two years now.
Neither do they realize that facilities on the SFF list are singled out due to quality problems identified and usually unresolved for an extended period of time, as reflected by the high CMPs and frequent DPNAs imposed against them.
They are grateful there is such a simple and transparent way to make this significant decision.
Susie simply thanks Michelle for her assistance in making this weighty decision, and confidently turns in for a nap.
The Five Star Quality Rating System
The five star quality rating system on the Nursing Home Compare website was created after Senator Ron Wyden of Oregon complained that it is easier to find consumer information on washing machines than on skilled nursing facilities.
This rating system was designed to help caregivers, patients, and their loved ones compare nursing homes and identify possible questions on particular facilities being considered.
On Medicare’s website, each Nursing Home is given an overall rating, as well as a separate one for the below three sub-categories.
- Health Inspections-
This is based on the three most recent health inspections and investigations due to complaints, with recent survey findings impacting the rating more than past surveys.
Compiled data on the amount of care hours provided to each resident by nursing staff. The different levels of severity in patient needs are a deciding factor when this rating is determined.
- Quality Measures (QMs)-
Here, information on how adequately nursing homes care for residents’ physical and clinical needs is provided.
Maintaining a great rating
Aside from nurturing positive relationships with hospitals, acute care facilities, and agencies to increase patient referrals, it is vital for LTC facilities to nurture a positive online presence, which boosts local SEO and makes it easier for potential residents to locate and be attracted to the facility.
In order to work on improving the online ratings, a facility administration must have an understanding of the performance measures the CMS uses to calculate stars in each category. Also, they must be able to collect, analyze, and report those performance measures both internally and externally. When the facts are understood and the information available, facilities can hopefully use this data to improve medical performance and the facility’s overall rating.
Karolee Alexander, director of clinical and reimbursement consulting for Pathway Health, a Minnesota-based long-term care consulting firm, offers guidance on how to improve nursing home ratings.
Here’s what can be done to improve each nursing home rating subsection. Lowering the score on each will increase the facility’s overall star rating.
Improving the Overall Score –
The Health Inspection Score is determined by adverse events that occur at a facility. The more residents potentially affected, the higher the event’s score. A minor situation will have a low score effect, perhaps even worth zero points, while a situation posing a high risk to all resident’s safety will have a high score effect – worth many points, and can negatively affect the rating.
- Improving the Health Inspection Score-
- Understand and educate your staff on all state nursing home health regulations.
- Using the Quality Assurance and Performance Improvement process, facility administration should identify, decrease, and improve areas of poor quality and safety performance.
- Roll out the performance-improvement changes to the entire nursing home, and implement these changes prior to your next inspection.
- Improving the Staffing Score-
- Be sure to accurately complete the staffing section on CMS Form 671, which is the application for Medicare and Medicaid certification.
- Follow all new federal regulations on competency-based nursing home staffing.
- Focus on retaining staff and staff recruitment, if applicable.
“Staffing is the number one challenge in nursing homes across the country,” Alexander said. “Keeping the good staff that you have is very important because there may not be other staff out there readily available to recruit.”
- Improving the Quality Measures (QMs) Score-
- Know what the data elements required for each quality measure are and gather this information.
- Review your MDS coding accuracy and improve them when possible.
- Review the clinical care and systems that affect quality and safety outcomes, and implement improvements where possible.
Other ideas that can improve QMs ratings include:
- Making quality improvements, reporting a priority, and including every single employee in the QAPI plan.
- Educating your staff on CMS quality measures and ensuring they have the skills, medical supplies, and equipment to execute those best practices.
Ensuring the Best Health Outcomes for Patients
Providing optimal wound care, and preventing and treating infection are crucial to maintaining a positive rating. Yet, it is important to focus on the entire patient, including the nutrition inherent in the meals served, socialization, and independence, as this will ultimately affect their overall health as well.
It Matters, To Those Whom It Should Matter Most
Keeping a positive rating on both Yelp and Nursing Home Compare are vital. It’s where prospective residents and their families will be getting their first, and hopefully not last, impression of your facility.
Anything you do to improve quality measures at your facility really matters to the most important factor; your patients.