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Does QIS Make Five-Star Harder To ‘Game?’

Dr. Andy Kramer
Provider Magazine – October 2014

The recent New York Times article entitled, “Medicare Star Ratings Allow Nursing Homes to Game the System,” caused quite a stir with the claim that the Five-Star Quality Rating System from the Centers for Medicare & Medicaid Services (CMS) is “…based in large part on self-reported data. …”

As providers well know, the base rating comes from survey results, which are anything but self-reported. The self-reported staffing and Quality Measure (QM) ratings are then applied to upgrade or downgrade the survey ratings. These latter two domains, as acknowledged by CMS, cover “only a brief snapshot in time” or “just a few aspects of care.”

In focus groups of providers conducted
shortly after the Five-Star system was publicly
reported, facilitators found that providers
also expressed concerns about the limitations of the staffing and QM ratings. But why not focus on the basis of the Five-Star system– a facility’s survey results?

This is where QIS can make a difference. The QIS process is based on objective measures of quality of care and quality of life, offering providers the best chance for improvements in survey results by improving quality. With 40 percent of surveys using the QIS last year, it is only a matter of time before the QIS rollout begins again.

More importantly, using the QIS methods as the basis for a center’s internal Quality Assurance and Performance Improvement (QAPI) process will result in a substantial improvement in survey results.

‘Improving survey results is not about conducting mock surveys.’

Improving survey results is not about conducting mock surveys, or trying to predict when surveyors are coming and which residents they will observe.

Rather, studies have shown that providers
can improve their survey results and reduce complaint deficiencies by improving resident centered care through continuous and comprehensive QAPI.

But what if one’s state uses the traditional survey process?

Studies have also shown that providers can improve traditional survey results as well as QIS survey results using QIS methods in QAPI.

After all, the regulations are the same, and the traditional survey process has become progressively more resident-centered through evolving surveyor practices.

So why tinker around at the margins of the Five-Star Quality Rating System when performance can be improved in the most influential domain, with enhanced quality that will be evident to consumers and referral partners alike? Providers can’t afford not to focus on the survey when it is evident that their health inspection ratings are regarded as the most credible domain in the Five-Star system.

The most important takeaway for providers from the recent Five-Star publicity should be that health care consumers and partners are increasingly relying on these ratings for making decisions that are critical to a center’s success.

Skilled nursing and post-acute providers are under growing pressure to compete for residents by improving their reputation and by demonstrating their capabilities and quality to acute-care and managed care partners.


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