Five-Star rating changes take effect this month

FRIDAY, APRIL 26, 2019

In March, the Centers for Medicare & Medicaid Services (CMS) announced the latest in a series of overhauls to the Nursing Home Compare website and the Five-Star Quality Rating System. According to an announcement published on the agency’s website, the changes take effect in April and are meant to improve the accuracy and value of information found on the Nursing Home Compare site and encourage quality improvement in nursing home care. Ultimately, it is hoped the updates will lead to better health outcomes for residents. CMS Administrator Seema Verma said, “Our updates to Nursing Home Compare reflect more transparent and meaningful information about the quality of care that each nursing home is giving its residents. Our goal is to drive quality improvements across the industry and empower consumers to make decisions, with more confidence, for their loved ones.”
The rating system
The Nursing Home Compare rating system gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have below average quality. There is one Overall 5-star rating for each nursing home and a separate rating for each of the following three factors:
· Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
· Staffing Levels: The staffing levels are the numbers of nurses available to care for residents in a nursing home at any given time.
· Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data. These measures address a broad range of function and health status indicators.
The changes
The CMS updates will include changes to the inspection process, enhancement of new staffing information and implementation of new quality measures. The agency will lift a 2018 ‘freeze’ on health inspection ratings that was put into place after a new survey process was implemented. CMS will resume the traditional method of calculating health inspection scores by using three cycles of inspections. Inspections occurring on or after November 28, 2017, will be included in each facility’s star rating. CMS explained that the ‘freeze’ was put in place to make sure all nursing homes were surveyed at least once under the new survey process and to prevent misaligned outcomes and inaccurate data.
CMS intends to promote nursing home quality by establishing new thresholds for staffing ratings. “Nurse staffing has the greatest impact on the quality of care nursing homes deliver,” the agency said. Previously, if a facility reported seven or more days per quarter without a registered nurse (RN) onsite, the facility was given an automatic one-star rating for the Staffing Levels category. Starting this month, a facility will get an automatic one-star rating if they don’t have a RN on-site for four days or more per quarter.
Ratings for the quality measures (QMs) are based on performance on 17 of the QMs that are currently posted on the Nursing Home Compare website. These measures address an overall percentage or number of the facility’s population that experience certain functions and health status indicators. The new QMs added by CMS include two additional ratings based on performance on separate quality measures for long-stay residents and short-stay residents. Long-stay residents are residents who are in the nursing home for more than 100 days. Short-stay residents are residents who are in the nursing home for less than 100 days.
According to a memo released by CMS’ Center for Clinical Standards and Quality/Quality, Safety & Oversight Group, the thresholds for quality measure ratings will also be revised, a system for regularly updating the thresholds every six months will be added and individual quality measures will be weighted and scored differently. Additionally, the long-stay hospitalization measure and a measure of long-stay emergency department transfers will be added to the rating system. Two measures from the Skilled Nursing Facility Quality Reporting Program (QRP) will also replace duplicate existing measures – short-stay percent of skilled nursing facility residents with pressure ulcers that are new or worsened and short-stay rate of successful return to home and community from a skilled nursing facility. CMS explained that the additional ratings are meant “to better identify the differences in quality among nursing homes making it easier for consumers to find the right information needed to make decisions.”
To learn more about Five-Star rating changes or to be regularly updated about CMS regulations, contact The Compliance Store at

Share Post