ISDH Exploring Changing the Survey Report Card Score Methodology

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Terry Whitson, Assistant Commissioner, and Kim Rhoades, LTC Director, presented a proposal for modifying the survey report card score methodology and presentation at the June meeting with LeadingAge Indiana, IHCA, and HOPE.  The proposal would represent a significant change in how the score is calculated and presented for consumers and would be the first major change in the scores in over 12 years.

The following were the principles of the new system as laid out at the meeting:

  • Simplified scoring system
  • A higher score reflects a better performing facility (as compared with the current system where a lower score is better)
  • All surveys and tags will be included (including federal) in the scoring except life safety code.
  • A ranking of life safety code deficiencies may be created as a separate comparison
  • More current than current system.  The current system may not include surveys going back as far as 15 months and may include surveys going back 4 years.  The revised system would be current through the biweekly update of the consumer reports and would include all surveys going back 30 months from surveys included on that report. 
  • All report card scores will be based on the same 30 month period.  A special run would occur on June 30 and December 31 and perhaps March 31 and September 30.
  • New facilities will be scored the same as other facilities and will have a score upon opening.  We may include an asterisk indicating that the facility is a new facility that has been open less than 30 months and not include in ranking for a period of time.
  • The scoring system is not based on survey cycles.  It is based on all surveys from the past 30 months regardless of cycle.

The following would describe the new system:

  1. Score is a rolling score based on all surveys in the past 30 months except for life safety code surveys.  FYI, 30 months was selected because it means that the report card will include the most recent two standard surveys under normal survey procedures.  Survey cycles however are not a factor in the system.  A facility that is designated as a special focus facility would have more than two standard surveys during the 30 month period.  
  2. The scoring is based on severity level as follows:
    • Substantial compliance:  0 points
    • No actual harm (D, E, F):  3 deduction points
    • Actual harm (G, H, I):  20 deduction points
    • Immediate jeopardy (J, K, L):  25 deduction points
  3. All tags are used in compiling the score. 
  4. The maximum (best) score for the 30 month scoring period is 300 points.  That would be no “D” or higher deficiencies in the 30 months.  For each survey in that cycle, any cited deficiency results in deduction points from that 300.  The higher scoring facility would have the best score.  A facility with deduction points greater than 300 receives a 0.

The three nursing home associations will meet on July 14th to discuss this proposal.  Because all tags are included (currently only 45 tags felt to be most important to resident quality are used), complaint surveys are included, and the third most recent survey drops off, significant changes in scores would occur for some providers. According to a spreadsheet provided by ISDH, if facilities are ranked from best to worst using both systems, 38 LeadingAge Indiana facilities would see their rank improve by 50 spots and 22 would see their rank decrease by more than 50 spots.

There are still a lot of issues to be discussed. For instance, a G, H, and I citation all deduct 20 points although the I is widespread while the G is isolated. It would make sense to keep the scores current every month rather than at only two points in the year. Should all tags be included? Finally and probably most importantly, should this new system be used for the Quality Add-On determination for the Medicaid rate?

For a list of all facilities showing current scores and scores under the new system, click here.  Remember, under the current system a low score is good and a high score is bad.  Under the proposed system a high score is good and a low score is bad. 


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