Medicare Star Ratings: It’s not where you start, it’s where you end up

Medicare star ratings

Medicare star ratings 0 to 5 in half star increments

The people attracted to the planned security of a Continuing Care Retirement Community (CCRC) have a lifetime of beginning with the end in mind. (Tip of the hat to Stephen Covey.) We figure we can be happy and engaged almost anywhere we’re together and healthy. Yes we love architecture and great hospitality, but we worry about when we’re not together or care when we don’t have the same capacity for choice and action. The time to focus on the nursing center within a CCRC or Life Care community is at the start.

Medicare rates nursing homes with a 5-Star rating system, in half-star increments. 5-Star is the best. Three categories are rated:

  • Health inspections — physical condition of the facility
  • Staffing — things like patient/staff ratio, staffing through the day and night, and professional certifications
  • Quality measures — results focused measures of outcomes produced and not just efforts

Overall or Combined — the subsections are rolled up into an overall rating as well. This is a “snapshot.” You or a loved one may have special needs where expertise in a particular area not covered by the Medicare Star Rating, for instance memory or dementia programming.

Medicare Star Ratings = Bonus 

4 and 5 Star ratings improve the reimbursement rates Medicare pays a nursing home under a bonus system to encourage high performance.

Medicare’s bonus system highlights a couple of things to keep in mind.

  • Your monthly check is not the only source of revenue for your CCRC. You want a CCRC that knows how to use other revenue streams to improve the security of its promises to you.
  • Medicare doesn’t pay for long-term care (LTC). Medicare’s payments to skilled nursing facilities or nursing homes are focused on recovery and rehabilitation, often following a hospitalization. The Medicare Star Ratings are focused on quality measures in this context, and not long-term care. But generally, the quality management systems required to do well in Medicare’s rating and reimbursements carry over to a facility’s approach to long-term care. Still ask when you tour, what quality measures do you track to assure staff and management performance delivering long-term care?

Working Hypothesis

We have a working hypothesis that higher Medicare star ratings correlate (go together) with higher community financial stability. We’ll be digging deeper to test this hypothesis with data.

Our experience in touring facilities is that they don’t always want to highlight or even show the nursing facility. You often have to ask to tour and ask for more information on the skilled nursing part of the continuum of care. This probably reflects marketing experience of not everyone wanting to articulate the risk of declining health. The sales staff want to get you in the front door. We concluded our audience is the prospective resident or resident who is planning ahead, or their advisors and family members charged with helping weight the big picture. You need to know about the nursing facility.

The big point is, don’t just look at the independent living part of a community. Part of what you’re buying is the other end of the continuum of care. The quality of nursing care matters to your and your family’s long-term satisfaction with the community.

Related Articles:   How to read Medicare Ratings for Nursing Facilities, and Is Medicare Rating Unreliable?

Also see: HealthGrove Nursing Homes Reporting