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Survey delays reduce nursing homes’ 5-star ratings and create legal and financial pitfalls
While it is widely understood that 5-star ratings for nursing homes do not always accurately reflect a facility’s true performance in real time, or even in a timely manner, less attention has been paid to the financial and legal headaches that the system classification system created for suppliers and consumers.
The complexities underpinning the 5-star rating system have to do with the process of data collection, analysis and implementation, as well as delays in inspection surveys due to a shortage of inspectors. The entire process is fraught with pitfalls, causing nursing homes with low ratings to be denied loan refinancing and incur revenue losses due to decreased occupancy.
This situation may also cause facilities to be unfairly excluded from participating in preferred networks for federal government incentive programs, which may be supported based on a facility’s star rating.
In short, an outdated classification can last for months on end, industry experts told Skilled Nursing News.
At the heart of the problem are two types of delays, those arising from survey delays and those related to the inevitable delay between data submission and its reflection in star ratings, according to industry expert Steven Littlehale, chief innovation officer at Zimmet. Healthcare Services Group. .
By definition, there is a six-month lag – or two quarters – between the time a facility submits data to the Centers for Medicare and Medicaid Services (CMS) and the time it is integrated into star ratings.
“Therefore, there is the concept of an expected delay when a facility is populating data from the minimum data set and PBJ files. AND [even as] they are submitting them on schedule to CMS – no one is late, no delays – but the operational processing of these data sets results in six months between the time a facility submits the data and the time that data is reflected in the ratings by stars,” Littlehale said.
On the other hand, there is another type of delay that is directly attributed to research delays. Due to these delays, some facilities have surveys from six years ago that are still being factored into 5-star ratings. Even though the nursing facility has made huge investments in improving quality, or even under new ownership, these outdated ratings affect the facility’s ability to refinance, he said.
Legal and financial problems
And so unintended delay, while intrinsic to the system, can have far-reaching consequences, Littlehale said.
In lawsuits, for example, lawyers often cite star ratings as evidence of a facility’s quality of care at the time of an incident. However, what they do not consider is the gap between the incident and the data reflected in the classifications. This discrepancy can significantly impact the outcome of legal proceedings, painting an inaccurate picture of a facility’s performance.
“What happens in court is that a lot of times the plaintiff’s attorneys will say, ‘Here’s the star rating that matches the date of the incident.’ And I always have to explain that if you want to talk about personnel or clinical outcomes at the time of the incident, you have to fast forward six months, or basically two quarters, in the MDS assessment and the PBJ data that reflects back to that incident period. ,” explained Littlehale.
However, if a facility undergoes an ownership change and subsequently improves its operations despite positive changes, outdated survey data continues to haunt them, influencing their eligibility for preferred networks and financial opportunities, Littlehale said.
Furthermore, there are regional variations in the timing of surveys.
“I looked at the average polling gaps between the most recent poll and the last poll and it varies a lot by state, and even within the state it varies a lot,” he said. “The problem is that if a facility has had a negative survey in the past and is not having the opportunity to update the data from that survey, that old survey, that incident that may have happened three or four years ago, is still being reflected in the latest survey. recent.”
A low rating due to a previous, already corrected citation will be reflected in the rating and work against the facility.
“Then this comes up in court where they will say, in the assessment of the premises, the rating is one and I will have to explain that whilst this is true, there has not been a surveyor in the building in over 24 months… The facility has not had the opportunity to clean its record, to get a new independent assessment – ​​and that is very unfortunate,” said Littlehale.
In fact, being denied funding or being excluded from such preferred networks on value-based programs due to a below-average star rating can deal a severe blow to a facility’s bottom line, further compounding the financial pressure caused by regulatory delays.
Meanwhile, delays in research can often exacerbate problems related to federal and state reimbursement, according to Tina Sandri, CEO of D.C.’s Forest Hills, who also serves on the Board of Governors of the American Health Care Association (AHCA).
“Inspectors are currently spending a disproportionate amount of time, compared to pre-COVID, researching complaints. And this is taking away their time to do regular research. So they are also dealing with staff shortages the same way we deal with staff shortages, which is why people are not receiving their surveys on time,” Sandri told SNN. “This can impact funding if you are receiving Medicare-Medicaid funding and your funding is withheld because your research is not actually done on time. This impacts [the facility’s] cash flow and ability to provide services.”
Solutions to avoid headaches with a 5-star rating
Sandri’s solution to avoiding survey delays – and related 5-star problems – is to have more certified professionals assess quality per installation than is currently the norm.
“As a provider, I really think that if we could expand the accessibility of certifications and training to [quality certified professionals]especially with a focus on complaints and customer service, we could essentially hit the low-hanging fruit of quality issues,” said Sandri.
Additionally, conducting peer-based surveys is a proactive approach to avoiding later citations and maintaining consistent quality, according to Robert Hurlbut, president of Hurlbut Care Communities, which operates 11 facilities in the New York area.
“We do peer reviews where our administrators act as employees of the New York State Department of Health, and they come in twice a year to do that. [an informal] survey. And if they find something wrong, they write it down. But that doesn’t [seen as] punitive,” Hurlbut told SNN.
A peer review is simply a preventative move and is internal to the organization, with administrators and department heads, from cleaning and laundry to diet and nursing, evaluating and helping to resolve issues within 30 days, he explained.
“It works,” said Hurlbut, who said not only has he avoided citations at his facilities, but a nice side benefit has been lower turnover among his team leaders and nursing home administrators.
“We have administrators who have been with me for 15 or 20 years,” he said.
That said, although quality is not compromised and the facilities remain in good standing with research, even this solution does not guarantee profits.
“I have about three edicts: take care of residents and employees, do really good research for the state health department and then make money – [money] it’s the last one,” Hurlbut said.
Need for systemic change
At the end of the day, Littlehale emphasized the need for systemic changes to address these issues. From a policy perspective, stakeholders should work together to decouple survey results from programs like the Five-Star Quality Rating System when delays make them unreliable, he said.
Additionally, he urges facilities to leverage data-driven approaches to tell their story – to lenders, referral sources and regulatory bodies. By presenting their clinical outcomes, staffing ratios and the impact of regulatory delays, facilities can advocate for fair treatment and mitigate the financial repercussions of outdated star ratings.
“The biggest offense is that consumers are being encouraged to use the 5-star system to make placement decisions and monitor care. However, it is terribly outdated,” Littlehale said. “Nobody wants that. Residents, families and service providers want to use current, accurate data to make important decisions.”
The spotlight next week will shift somewhat to the Federal Reserve’s second-quarter earnings season and monetary policy. Market watchers will be treated to results from several major names, including Dow 30 components Goldman Sachs (GS), UnitedHealth (UNH), Johnson & Johnson (JNJ) and American Express (AXP), along with streaming giant Netflix (NFLX).
The Fed will still attract some attention as investors will be eager to hear from a packed lineup of central bank speakers just before the policy meeting lockout period.
In terms of the economic calendar, after fifteen days of labor market and inflation indicators, activity data will gain momentum in the form of the latest retail sales and industrial production reports.
Earnings Highlight: Monday, July 15 – Goldman Sachs (GS) and BlackRock (Black). See the full earnings calendar.
Earnings Highlight: Tuesday, July 16 – UnitedHealth (UNH), Bank of America (BAC), Progressive (PGR), Morgan Stanley (IN), PNC Financial (PNC) and JB Hunt Transport (JBHT). See the full earnings calendar.
Earnings Highlight: Wednesday, July 17 – Johnson & Johnson (JNJ), US Bancorp (USB), Morgan Children (KMI), United Airlines (UAL) and Ally Financial (ALLY). See the full earnings calendar.
Earnings Highlight: Thursday, July 18 – Netflix (NFLX), Abbott Laboratories (ABT), Black stone (BX), Domino’s pizza (ZDP) and Taiwan Semiconductor Manufacturing (TSM). See the full earnings calendar.
Earnings Highlight: Friday, July 19 – American Express (AXP), Halliburton (THANKS) and Travelers (VRT (return to recoverable value)) See the full earnings calendar.
IPO Observation: Hospital and healthcare clinic operator Ardent Health Partners (TARDT), insurance service provider Twfg (TWFG) and the biotechnology company Lirum Therapeutics (LRTX) are expected to price their IPOs and begin trading next week. The analyst quiet period ends at Rectitude (RECT) to free up analysts to publish ratings.
Police cars outside the residence of Thomas Matthew Crooks, the suspected shooter at a Trump rally on Saturday, investigate the area in Pennsylvania. Following the incident, one rally attendee was killed, two rally attendees are in critical condition and Donald Trump suffered a non-fatal gunshot wound. The shooter is dead after being shot dead by the United States Secret Service. (Photo by Kyle Mazza/Anadolu via Getty Images)
Investors will initially favor traditional safe-haven assets and may lean toward trades more closely tied to former President Donald Trump’s chances of winning the White House after he survived an assassination attempt, according to market watchers.
“There will undoubtedly be some protectionist or safe-haven flows into Asia early this morning,” said Nick Twidale, chief market analyst at ATFX Global Markets. “I suspect gold could test all-time highs, we’ll see the yen being bought and the dollar, and flows into Treasuries as well.”
Early market commentary suggested Trump’s shooting at a rally in Pennsylvania on Saturday could also prompt traders to increase his likelihood of success in the November election. His support for looser fiscal policy and higher tariffs is generally seen as likely to benefit the dollar and weaken Treasuries.
An indicator of market sentiment heading into the weekend: Bitcoin surged above $60,000, likely reflecting Trump’s pro-crypto stance.
Other assets positively linked to the so-called Trump trade include stocks of energy companies, private prisons, credit card companies and health insurers.
Traders will also be closely watching market measures of expected volatility on Monday, such as those in the tariff-sensitive Chinese yuan and Mexican peso, which have begun to price in the U.S. vote.
Trump said he was shot in the right ear after a shooting at his rally. His campaign said in a statement that he was “fine” after the incident, which prompted him to rush off the stage.
“Currencies will be the first major market on Monday in Asia to react to the weekend’s shots. There’s potential for extra volatility, and getting a clear reading could be especially difficult because liquidity will be hurt by Japan’s national holiday,” said Garfield Reynolds, Asia team leader for Bloomberg Markets Live.
Strategists had already expected a volatile run-up to the election, particularly as Democrats are still agonizing over President Joe Biden’s candidacy after his poor performance in last month’s debate raised questions about his age. Investors were also grappling with the possibility that the election could end in a drawn-out dispute or political violence.
But there is little precedent for events like those in Pennsylvania. When President Ronald Reagan was shot four decades ago, the stock market plunged before closing early. The next day, March 31, 1981, the S&P 500 rose more than 1% and benchmark 10-year Treasury yields fell 9 basis points to 13.13%, according to data compiled by Bloomberg.
Bond investors should pay particular attention as the attack is likely to boost Trump’s election chances and ultimately lead to concerns about the fiscal outlook, according to Marko Papic, chief strategist at California-based BCA Research Inc.
“The bond market must at some point become aware of President Trump’s greater chances of winning the White House than any of his rivals,” Papic wrote. “And I continue to believe that as his chances increase, so too must the likelihood of a bond market revolt.”
Kyle Rodda, senior financial markets analyst at Capital.com, said he was seeing client flows into Bitcoin and gold following the shooting.
“This news marks a turning point in American policy norms,” he said. “For markets, it means safe-haven trades, but more tilted toward non-traditional safe-havens.”
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Jio Financial share price: Should you buy this Reliance group stock on Monday ahead of Q1 FY2024 results?
Q1 2024 Results: Jio Financial Share Price will be in focus on Monday as the Reliance Group company has a fixed board meeting on July 15, 2024 to consider and approve the company’s unaudited standalone and consolidated financial results. Trust Group company informed about the Q1 2024 Results date on Wednesday last week via an exchange filing. According to stock market experts, Jio Financial Services Limited is poised to deliver impressive Q1 results for FY25 on solid operating income. They have forecast a healthy QoQ PAT for the company in Q1 FY25.
Jio Financial Services News
Speaking on the Jio Financial Services Q1 2024 results, Manish Chowdhury, Head of Research, StoxBox, said, “We believe Jio Financial Services is poised to deliver impressive results in Q1FY25 aided by its operating income, which is likely to show robust growth driven by strong investment income, which in turn should lead to healthy PAT growth on a sequential basis. Jio Financial Services continues to make strategic moves such as launching digital products and expanding its ecosystem, with a clear focus on future growth. The company has announced plans to introduce products for lending against stocks and mutual funds, leveraging Jio’s large user base, which could be a significant growth driver in the coming quarters.”
“Furthermore, with the NBFC receiving RBI approval to become a primary investment company, Jio Financial Services is well-positioned to unlock value from its investments. Overall, we expect the company to report robust numbers in the upcoming quarter,” the StoxBox expert added.
Jio Financial Stock Target Price
Speaking about the technical outlook of Jio Financial share price, Ganesh Dongre, Senior Manager, Technical Research at Anand Rathi, said, “Jio Financial Services share price is poised to make a fresh high at the ₹260 apiece level. If the stock breaks above this mark, the Reliance Group stock could make a fresh high by touching the ₹290-₹295 zone. Hence, those with Jio Finance stock in their portfolio are advised to stick to the script by keeping a stop loss at ₹205. If the stock breaks above ₹260 decisively, then one can upgrade the stop loss at ₹240 for the near-term target of ₹295.”
On the advice to new buyers regarding Jio Financial stock, Ganesh Dongre said, “New buyers are advised to wait for the breakout. Once the stock breaks above â‚ą260, one can buy this Reliance Group stock at the short term target of â‚ą295, keeping a stop loss of â‚ą240 apiece.”
Disclaimer: The views and recommendations made above are those of individual analysts or brokerage firms, and not of Mint. Investors are advised to consult with certified experts before making any investment decisions.
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