McKnight’s Articles

Sometimes you don’t need a predictive analytic when common sense will do

One month … in Miami … in January? Sure, why not? After all, since I’m on the road several times a month, it really doesn’t matter where I call my home, or office in this case.

Winter in Boston can be so cold and inhospitable, it would be foolish to turn down a few weeks in a more compelling environment. Plus, I get to bring my family, including Melvin and Theodore, our adored Shih Tzus.

It’s during a walk with our two favorite, furry boys and an “odd almost-encounter” at the dog park that causes me to reflect on an update made just before the new year to our correlational studies between survey, staffing and clinical outcomes, and rehospitalizations. My perverse motivation to request this update from our analytics team can be easily understood by reviewing the Centers for Medicare & Medicaid Services’ press release announcing the official start to the “Pathways to Success”accountable care organizations and the reasserted role of Five-Star outcomes in accessing the desirable three-day waiver available to approved ACOs and their skilled nursing facilities.

SNF affiliates of these new ACOs must maintain an overall rating of three stars or more to participate in the ACO models and receive the three-day waiver. The latter is not a new concept but has not always been leveraged. Pathways to Success changes that. Yes, once again, the importance of Five-Star outcomes increases at a greater velocity than a cupcake out of the Magnolia Bakery.

To be clear, I’m a fan of the three-day waiver. It’s a vehicle to return the patient/resident to a lower, less-costly care setting as quickly and as safely as possible. It’s good for everyone to have this option in place, especially in certain cases where cognitive impairment or frailty are present. Perhaps it’s more appropriate to advocate for the removal of the three-night requirement to access the Medicare Part A skilled nursing benefit. However, it would be disingenuous to claim that this wouldn’t be abused. But what do three or more stars in overall Five-Star have to do with anything?

As it turns out, very little.

Continue reading Steven Littlehale’s guest blog on