High Five-Star Ratings Don’t Correlate with Lower Rehospitalization Rates

While individual star ratings are important for skilled nursing providers, a high number doesn’t always mean they are providing the best care and seeing lower rehospitalization rates.

As the skilled nursing industry continues to adapt to new value-based care models, the importance of the Five-Star Quality Rating System from the Centers for Medicare & Medicaid Services (CMS) has steadily grown. While they was initially introduced in 2008 as a resource for consumers and their families, the rise of accountable care organizations and other initiatives have increasingly made them a benchmark for referral partners — perhaps an unintended consequence of the system.

Each facility’s rating is based on a range of factors, including staff metrics and quality measures, but the number-one driver remains survey performance, according to Steven Littlehale, executive vice president and chief clinical officer at analytics provider PointRight.

“[The rating] has very little to do with quality and a lot to do with survey,” Littlehale during the National Investment Centers for Seniors Housing & Care (NIC) Spring Investment Forum Dallas last month.

Littlehale admits that a building’s rating carries weight, but the quality of care being provided on average isn’t all that different when you look at the hospital readmission rates — a key metric in the new payment landscape.

The Cambridge, Mass.-based PointRight found only a 3% difference in the median adjusted rehospitalization rate between the highest- and lowest-rated facilities.

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“We can grumble about [the star ratings], and there is a clear difference between a five-star facility and a one-star, but it gets a little murky after that,” he said.

The true meaning and value of the ratings system remains the subject of study and debate. A report from financing firm Lancaster Pollard last year argued that investors shouldn’t be afraid of searching for hidden potential in one-star facilities — noting that “not all one-star facilities are created equal” — while a study from the Colorado School of Public Health found concrete increases in census for facilities that were able to boost their surveys enough to earn an extra star.

More controversially, another study from the University of Connecticut and Florida Atlantic University unearthed evidence of nursing homes inflating their self-reported quality measures in an attempt to artificially increase their star ratings.

PointRight’s data adds to the discussion by pointing out that facilities with low star ratings could still be providing exceptional care in rehospitalizations — and thus potentially still deserve a place in competitive health care networks.

“If it’s about rehospitalization, Five-Star is not a great proxy for rehospitalization success,” Littlehale said.

Written by John Yedinak

Photo Credit:

John Yedinak

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