EPISODE 33 — Medicare Ratings: Why You Cannot Trust What’s Published (They’re TWO YEARS Old!)

EPISODE 33 — Medicare Ratings: Why You Cannot Trust What’s Published (They’re TWO YEARS Old!)

Most families don’t know this—but the Medicare star ratings handed to you in the hospital are two years out of date. And those outdated numbers can dramatically impact the choices you make for skilled nursing, rehab, and home health care.

In this episode, Jamie Callahan sits down with Breann Drake, Regional Director of Business Development for Volare Health, to expose why these ratings don’t reflect real-time quality, what they actually measure, and how they can mislead families during critical decision-making moments.

Breann breaks down:
 ✔️ Why CMS star ratings lag two years behind real-world performance
 ✔️ What the ratings measure (hint: mostly paperwork—not care quality)
 ✔️ How outdated scores affect funding, staffing, and patient placement
 ✔️ Why “quality measures” on Medicare.gov tell the true story
✔️ How to evaluate a skilled nursing or home health provider the right way

If you have a loved one in the hospital—or expect to someday—this episode will help you make safer, smarter, informed care decisions.

 🔎 Do your own research: Medicare.gov → Search facility → Scroll to Quality Measures

At Team Senior™, our mission is to guide you and support you through the maze of Southern Oregon Long-Term Care.

📞 For Team Senior resources, call: 541-295-8230

Or visit our website for more information: https://www.teamsenior.org/

Transcript

I'll correct that throughout the transcript:

TEAM SENIOR PODCAST - TRANSCRIPT

Episode 33: Medicare Ratings - Why You Cannot Trust What Is Published - It's TWO YEARS Old!

Host: Jamie Callahan
Guest: Breann Drake, Regional Director of Business Development, Volare Health

JAMIE CALLAHAN: Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging. Society grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke, or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia. That's our area of expertise, and we are here to share our insight.

And now, the Team Senior Podcast.

Hi, this is Jamie Callahan, and we are in the studio again with Breann Drake. She's been here once before. She's with Volare, and Volare owns several skilled nursing and rehab facilities, not just in Oregon, but also in Hawaii. And we are here to talk about a hot topic. This is something that is revolving in the community all the time, and it is especially important to skilled nursing facilities and home health agencies. So Breann, I want to give you a chance to talk a little bit about you, your role with Volare, and then we're going to dive right into this.

BREANN DRAKE: I am Breann Drake. I am the regional director of business development for Volare Health, and I oversee six buildings for our company. And yeah, I've just been in this industry 15 years, so excited to chat about this.

JAMIE: All right, so I've had this conversation with many different people, and we have talked at length about the need to write some articles, get this on the podcast—all the things. So when someone is admitted to the hospital, they are handed a piece of paper that provides them with information about the organizations that they are being referred to, usually as companies—home health companies, skilled nursing facilities. And those companies come with what is referred to as a Medicare star rating. The unfortunate thing about those ratings, which is specifically what we are going to talk about today, is that those are two years old. Every single thing that you are provided by the hospital that tells you which companies to use and which companies maybe aren't at the top of that list—that information is two years old. And the hospital is bound by some regulation or rule that does not allow them to provide you with updated information. Walk us through that.

BREANN: Yes, absolutely. So those CMS ratings come out every two years, even though we are all being graded, like we would be in school. So all skilled nursing facilities, hospice companies, home health—we're all being rated all the time, on a daily basis.

JAMIE: Absolutely. Daily basis.

BREANN: And so they take those numbers, and that's what they make their averages for a star rating as. I think some families think Google and a star rating are about the same, which they're not. So that CMS rating that they're seeing is off of a grade scale from two years ago that is catching up because the government is behind all the time in their stuff. And it just goes off of metrics. So what they're looking for is different screenings. How are we with vaccinations? How are you with blood pressures? It's a lot of documentation that determines these star ratings. So a lot of people think it's overall care. It's really not.

JAMIE: It's not based on the physical therapy that you're receiving.

BREANN: Correct.

JAMIE: It's not based on the food that you're getting. It's not based on whether somebody was on the floor for 30 minutes or not.

BREANN: Correct.

JAMIE: What is it based on?

BREANN: It is absolutely based on the metrics of—like I said, how many vaccines we're giving out, how much blood pressure screening, our medication rates, how much medication—psychotropic medications—we're handing out, how much of that are you doing? Are we staying in compliance with what CMS regulations say for how quick we respond to someone being sick or having to call the doctor or call 911? It's a lot of documentation. So it's not really showing you the true story of how the care within that facility is going.

JAMIE: Understood. Understood. And I think that this is so important to bring to the attention of our community, because if you are in the hospital today and you are looking at a five-star rating for a home health or skilled nursing facility, and you are choosing based on the star rating, but little do you know that facility's been shut down for the last 18 months because they're on stop placement—but guess what? The hospital isn't going to tell you that, and I'm pretty sure they're not even allowed to share all of those details because what they are allowed to share is the star rating provided by Medicare, which again is two years old.

BREANN: Yes, exactly. And that's why a big thing that we push is: educate yourself. Look on this. You can go right to medicare.gov. There is a website on there, and it will tell you every star rating for anyone you look up. And you can go on there, and there's a little tiny spot at the very bottom. It says "quality measures." Now that is the star rating you want to be looking at for everybody that you come to. Quality measures—

JAMIE: It speaks for itself, right? That's what you want to be looking for.

BREANN: Absolutely. Because that's where you're going to see the quality of care and the quality of what's going on within a facility.

JAMIE: Understood. Understood. So we deal with this with lots of different things. Companies are purchased or sold, staffing changes, an administrator moves from one building to another, and that overnight impacts the quality of the services that you're going to be receiving. My recommendation always—and I would be interested to know what you have to say about this—is that you should not just look at what you are going to read online, but you should be talking with the people around you, your nurses—not just your family members who are going to say, "Oh, my grandma passed away there," but the family members that might work in our industry that can really give you a bigger, broader picture about what is happening from each of these services. We see this happen with every kind of business that's out there, whether it's pharmacy, home health, hospice, whatever. Like I said, anything can impact the quality of the care. And that doesn't happen from two years to two years. That can happen in a matter of a day or a month.

BREANN: Absolutely. And I really think that's where community leans on community. And that's where us being in a small area is really—digging deep into there and seeing that. And that's why I push quality measures. I've—I'm going to look for my family. That's what I want to look for. Yeah. Is the quality.

JAMIE: Absolutely. And talking—

BREANN: Talking, yes.

JAMIE: Talking to people. That's probably the biggest advocacy that anybody can do, really, for anything, not just in this industry. How would you say it's impacting patient care and benefits?

BREANN: Oh, big time. Absolutely. Especially with the benefits piece of it. That is where you are going to see the numbers change. You're going to see quality measures change. You're going to see all of that because, again, everything is revolving around this CMS rating. So if our CMS ratings are low in a facility, we're not going to get the kickback. I get—it's not even a kickback. It's more like we're not going to get funding.

JAMIE: Yes.

BREANN: That's what I was looking for. And I get that funding from insurance companies or different things like—we might not get even Medicaid. VA's going to pull out. They're not going to stay there. Your star ratings really can affect—so we've got so much veteran in this area, and if your star ratings are low, they're not going to allow their patients to go there.

JAMIE: So the curious thing about this, and I need to ask it in a way that is in the most layman's terms—what you're saying, what I think I hear you saying, is that your CMS ratings are based on documentation, paperwork, number of people getting vaccinated, communication with physicians, et cetera. But it's not necessarily being based on how efficiently, quickly is somebody actually rehabbing and the quality of caregiving and therapy services they're receiving. Correct?

BREANN: Absolutely correct.

JAMIE: It's dumbfounding to me.

BREANN: Yeah, it's—and that's what's hard to hear when you know, as we've—you know that they come in, they're at once a year, they survey us, they come in, they grade us like on a scale of one to ten. They're grading us on everything, and there's tons of different state regulations and guides and everything else you can think of. And that right there is almost 90% paperwork.

JAMIE: Yeah, and I will echo that, because the way that I got into this business was probably about 15 years ago. I was working with an adult foster home, and I was always very—combination of feelings—excited and anxious about the state coming into the home. I was excited because I knew that I was providing exemplary care. Beautiful rooms. Their favorite hot chocolate served at three o'clock in the afternoon every day. The entire menu was designed to cater to what they wanted on the menu, like all the things—over-the-top, super quality caregiving. But the state would come in, and they would see that I didn't indicate what the drink was going to be on a Thursday night on my menu, or they would see that my Tylenol is expired by two days for a resident that hasn't even taken it for a year, or things from my perspective that were very insignificant revolving around the quality of someone's care. And so what happens is that they document all of this. They give you violations. Sometimes they give you fines for those things. And then when a consumer is on a website looking at what those violations are, the other really unfortunate thing is that when the state writes the violations, they are really confusing.

So let's say, for example, that I have a caregiver whose background check has expired. And you know what? Maybe that caregiver has already reapplied for their new background check, but it hasn't come in yet. When the state writes that violation, it's going to sound something like, "I harmed my residents by neglecting to provide them with safe caregiving," or something like that. Yeah. So as a consumer, when you read that violation, you are horrified by the thought of going into this foster home because they don't provide the details.

BREANN: Absolutely. And that's exactly what you get. And any of them that you read when there is that stop hand on there, and it talks about a harm tag—examples, we've had them before in our buildings. They're called an IJ. They're an immediate jeopardy tag. They can walk in there, and it was literally because there was a lighter in a patient's room that did not get removed when they came in from smoking. Yeah.

JAMIE: And oftentimes those are things you can't even control because families are bringing things in. People have things in their pockets. But again, the way that the surveys are being presented to the general population, or the way that surveys are being performed and then recorded for the general population to read—like in the foster home setting—it is really daunting for the folks that are trying to provide exemplary care.

BREANN: Absolutely. And it's hard as a consumer being the patient and the consumer's out in there and looking at that. If you and I are reading that for our family and I see that, of course I'm going to be like, "I'm not taking them there then," because they put people in jeopardy every day. Yeah. And that's scary. And that's something we're up against all the time, which is why our marketing team is out there so heavily trying to explain what that means. And that's why we push those quality measures more, because I can pull those up and they can read those quality measures to see, "Oh, okay, that's not what that means. Just because there's a stop hand there doesn't mean that you're going to harm grandma or grandpa or my parents or anything." You actually might have forgot to chart something.

JAMIE: Right. Yeah. I am so happy that we're finally talking about this. So I'm going to wrap it up, but I want you to quickly share again: when people want to take a deeper dive into those stars, how do they do it?

BREANN: Go to medicare.gov, and in there it will literally let you type in any name. You can type Highland House, pull up Highland House, and then it will pull our star rating immediately. And then at the very bottom, it'll say "quality measures," and that's where you can see the real true action of what's happening in a facility.

JAMIE: Please do that. I'm really encouraging our community to advocate for themselves and not just follow an archaic system where you're receiving information that is two years old when you're discharging from a hospital. That makes absolutely no sense at all. Thank you, Breann, so much for being here today. It's always a pleasure getting to spend a little bit of time with you. Do you have anything you want to add?

BREANN: No, I appreciate it. Thanks so much.

JAMIE: You got it. Have a wonderful day, everyone.

Thank you for listening to the Team Senior Podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away. Team Senior can be reached at 541-295-8230. Again, 541-295-8230. Until next time, this is Jamie Callahan.

END OF TRANSCRIPT