CMS Five-Star Quality Rating System
UPDATE: Aug. 10
On Aug. 10 the Centers for Medicare & Medicaid Services (CMS) published new Five-Star rankings on its Nursing Home Compare (NHC) website. The ratings reflect new metrics and methodological changes that expand the quality measure component of the system.
On May 3, PHCA hosted a webinar, Navigating the CMS Quality Measures, that walked through these new changes. Members can access the recorded webinar and the following resources on the PHCA website:
- CMS Technical Users’ Guide here
- Q&As from July 28 Five-Star Webinar
- Member center toolkit containing the following items:
- Suggested talking points
- Template media statement
- Template letter to families
- Sample letter to payors
AHCA members can download additional resources, including suggested talking points and a template media statement, here.
If you need any assistance with media inquiries or talking points, contact Eric Kiehl, PHCA Director of Communications at firstname.lastname@example.org or 717-221-7935.
And be sure to use AHCA’s members-only LTC Trend Tracker here to run reports that capture your Five-Star and Quality Measure (QM) rates.
The Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System was created to help consumers, families and caregivers compare nursing homes when rehabilitation or skilled nursing service needs are required. The CMS Five-Star website features a quality rating system that provides one source of data for selecting a nursing home. The Nursing Home Five-Star Quality Rating System rates each nursing home between one and five stars. Each nursing facility receives an overall score which is calculated by star ratings in three categories—Health Inspections, Staffing and Quality Measures. Nursing facilities with five stars are considered to above average quality and nursing homes with one star are considered below average quality.
- Health Inspections: The health inspection rating is comprised of information from the last three years of onsite inspections, including both standard and complaint surveys utilizing a weighted system.
- Staffing: The staffing rating considers differences in the levels of residents’ care need in each nursing home and provides information about the number of hours of care provided on average to each resident each day by nursing staff.
- Quality Measures (QMs): This information is collected by nursing homes for all residents and offers information about how well nursing homes are caring for their residents’ clinical and physical needs based on predetermined CMS quality measures.
CAUTION: No rating system can address all of the important considerations that go into a decision about selecting a nursing home for a specific individual. Consumers should therefore only use the CMS Five-Star Quality Rating System together with other sources of information for the nursing homes. Nursing Home Compare has detailed information about every Medicare and Medicaid-certified nursing home in the country, including each facilities five-star ratings.
The CMS Five-Star Quality Rating System is a significant piece of a nursing facility’s overall quality strategy. As financial, quality and operational models become more tightly integrated understanding the overall CMS Five-Star methodology and each element that comprises the five-star rating becomes an important component in telling your quality story.
On , CMS posted new quality measures on Nursing Home Compare. The ratings reflect the following key changes:
- The addition of five new QMs; four of the five quality indicators focus on individuals admitted to a center for short-term rehabilitation following a hospital stay. The five new measures are:
- Percentage of short-stay residents who were successfully discharged back to the community (claims-based)
- Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based)
- Percentage of short-stay residents who were rehospitalized after a nursing care center admission (claims-based)
- Percentage of short-stay residents who made improvements in function (MDS-based)
- Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
- In July 2016, the new measures will have 50 percent of the weight of the current measures.
- In January 2017, they will have the same weight as the current measures.
- The methodological changes include:
- Using four quarters of data rather than three for determining QM ratings.
- Reducing the minimum denominator for all measures (short-stay, long-stay, and claims-based) to 20 summed across four quarters.
- Revising the imputation methodology for QMs with low denominators meeting specific criteria. A facility’s own available data will be used and the state average will be used to reach the minimum denominator.
- Using national cut points for assigning points for the ADL QM rather than state-specific thresholds.
Members are encouraged to review the agency’s updated Technical User’s Guide for additional details about these changes.