"The last thing we want to do is have an arbitrary bell curve just for the sake of having a system," Sebilius was quoted this week as saying at McKnight's LTC News. The Health and Human Services Secretary was commenting on the lacklaster five-star consumer system imposed by CMS in 2008. It has received less than shining reviews from providers.
Sebilius should be aware how strongly providers feel about her statement. The fault of the system is that it forces all provides into a single pre-determined quintile, arbitrarily moving individual facility scores around during the year as other providers complete survey cycles. Rather than measuring quality improvement, it is strictly comparative, and certainly not on a real-time basis. Additionally, many facilities and organizations usie their survey as a true quality improvement process tool, and make significant improvements 3-6 months after a health survey. The system forces a single score on providers for up to 17 months at a time, quality measures component aside.
The Secretary seems to agree with providers that an improved system would include all three componets, namely better measurement and explanation of quality measures. "If everyone ends up being excellent or everyone ends up being failing, so be it,” continues Sebilius. We couldn't agree more. While CMS is unlikely to open up to most provider recommendations, we can continue hope and lobby for reform in this area. Until then, just know that a facility in another state could bump you from a three-star community to a two-star community with one good survey.