Tail wagging the dog …

A very troubling sign indeed.  For those of you well-versed in the CMS 5 star rating system for skilled nursing facilities, after reading this I’ll bet you say, ‘I didn’t see this coming.’

A nursing home administrator recently told me that his census was in the decline.  It didn’t fall off a cliff.  It’s been a gradual fall.  From an average occupancy rate of about 94%, he’s down to about 73%.  His Medicare census is also down about 33%.  His building is a leader in its market.  What happened?  A major side effect of the 5 star rating system.  Here’s the story …

A relatively new 50-ish bed, all private room facility in the market was unhappy with its low star rating.  The Quality Measure component was killing them. (For a 5 star rating system introduction, check this out.) They reasoned that since the 14 day MDS data was hurting their score, they would simply discharge their Medicare patients on day 14.  Their new message to the market, ‘We have beautiful private rooms and we get you home faster than anyone else.’

Of course they don’t mention …

  • the harm they cause by sending patients home too soon.
  • They don’t publicize what percent of their discharges end up in the hospital again.
  • They don’t emphasize that these medicare patients are being cheated out of their rightful benefit of receiving therapy/care so that they heal fully before going home.

Nope.  Instead, they are sucking the long-term care patients out of the market and everyone else is suffering.  What’s an administrator to do?  How do you compete with that?  We came up with a game plan to go on offense in his market.  The good news is there’s quite a bit he will do and he’ll be fine.  The point of this post is to call attention to UNINTENDED CONSEQUENCES.  I’m sure CMS did not intend for this side effect of the 5 star rating system.  This story proves again that ‘we perform according to how we’re measured.’  A primary concern, therefore, as a leader is to be sure that your measures and rewards promotes the type of behavior you want.  Unfortunately, clairvoyance, isn’t bestowed with title of ‘Leader,’ so we have to be attentive and willing to change our measures/rewards as we discover these things.

Will CMS change the measure to avoid this side effect?  I hope so …

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