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. 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 — the 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. Health plans earning at least four stars qualify for federal bonus payments. Those that don’t, lose out.

Since the bonus payments began in 2012, the percentage of Medicare plans earning 4 stars or more has doubled to 40 percent, reports the Kaiser Family Foundation.

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 focus on recovery and rehabilitation. Therefore, Medicare’s rates focus on quality in recovery/rehab rather than long-term care. But…generally, the quality management required to do well in Medicare’s rating do carry over to a facility’s approach to long-term care. Still, ask about their quality metrics. Ask what measures they track. Not only what’s tracked, but how they use this data. Good metrics should inform management to adjust and maintain quality staff and performance

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.

Facility marketing personnel often will not even show the nursing facility on tours. 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. If you’re like us, as a prospective resident you do want the full picture.  You’ll not only need to tour but it is critical you tour. You want to know the details about the nursing facility.

The big point: 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. It 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?