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Expanding 5-star system foreshadows your future

July 17, 2015
by Julie Miller, Editor in Chief
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This week, the federal government announced it is now ranking the quality of home health agencies, assigning them one to five “stars.” Medicare also offers its five-star ratings for hospitals, nursing homes, dialysis centers, Medicare Advantage health insurance plans and prescription drug plans.

In many cases, the providers and payers are receiving payment increases and other perks for earning high scores. Or, depending on how you look at it, you could say they are being penalized for earning low scores.

Not surprisingly, federal health officials are also obligated under the Affordable Care Act to begin posting quality ratings for the commercial health plans that are selling their policies on the marketplace exchanges next year. That’s interesting because it’s the first time the feds will be rating commercial insurance. All the federal scoring tools include consumer survey data as well.

You see where this is going, don’t you?

Why you should care

As the behavioral health landscape continues to see a consolidation trend, the next logical step in this operationalization of the market will be the expectation of a comparative quality rating system. If a significant number of smaller, local providers evolves into a short list of big, national or regional providers, everyone will want to know how to differentiate them. 

It won’t necessarily be the federal government driving the cause—although I would never rule that out—but it could be the insurance companies and consumers who ask for the familiar five-star rating systems to be applied to mental health and addiction treatment.

Addiction treatment is probably one of the most consumerized health segments in the country, and it’s surprising to many that validated rating systems similar to Medicare’s five stars don’t really exist. One think tank, the Washington Circle Group, has designed three administrative measures for the industry so far, but forward progress seems pretty slow. There are also anonymous survey tools that aggregate consumer feedback on treatment experiences, but they have no way of verifying any of the data. I could easily stuff the ballot box with bogus reviews, and no one would know.

List of measures

To measure quality, Nursing Home Compare uses staff ratios, health inspection reports and clinical measures such as the incidence of urinary-tract infections and pressure ulcers. I’m sure the marketplace health plans will use, in part, existing scores from a long-standing program that tracks everything from mammograms to diabetes control.

What measures would you use to rate behavioral facilities? It seems like a daunting task to agree on a set of measures as an industry, but it certainly can be done. Remember the perfect is the enemy of the good.

There’s an opportunity to self-regulate here. Create your own measures. Don’t wait for the government or any outside force to come in and impose a half-baked star-rating system on you. Worse, don’t wait for a bunch of different rating systems to emerge that will have you doing twice the administrative work to track and report. Comparative quality must be on your radar.

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Julie Miller

Editor in Chief

Julie Miller

@editor_JMiller

Julie Miller has more than 14 years of experience observing, analyzing and reporting on various...