CMS 5 Star Rating Update: What Does This Mean for LTC?
In February 2015, the Centers for Medicare & Medicaid Services (CMS) publicly announced changes to the five‐star rating system used on its Nursing Home Compare website (NHC).1 Nursing Home Compare 3.0, is an expanded and strengthened system that analyzes provider data across multiple quality measures and uses CMS data to rank providers on a scale of 1 to 5. The ranking system has been under fire for years because much of the data points are self‐reported and unverified, creating confusion for consumers, who may assume that the rankings are based entirely on CMS‐collected data.2 Starting January 2015, nursing home star ratings will include:
Addition of 2 Quality Measures (QMs)
One measure is for short‐stay residents when a nursing home begins the use of antipsychotics for residents without diagnoses for schizophrenia, Huntington’s disease, or Tourette syndrome. The second measure reflects continued use of such medications for long‐stay nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
Adjust Staffing Algorithms
This revision will more accurately reflect adjustment to staffing levels. Nursing homes must earn a 4‐star rating on either the individual Registered Nurse (RN) hours only or the total staffing hours to receive a 4‐star rating on the overall staffing rating and can have no less than a 3‐ star rating on either of those dimensions.
Expansion of Targeted Surveys
State Survey Agencies are, to conduct specialized, onsite surveys of a sample of nursing homes across the U.S. that assess adequacy of resident assessments and the accuracy of information reported to CMS that is used in calculating QMs used in the rating system.
The changes in calculations of ratings reflect that CMS has raised the bar for the type of performance that should be recognized as high quality and anticipates nursing homes will make quality improvements to achieve these high standards.
Decline in Quality Measure Star Rating
Since CMS standards for performance on quality measures are increasing, many nursing homes will see a decline in their QM star rating. By making this change, NHC will include more meaningful distinctions in performance for consumers and focus nursing homes on continuously improving care focused on residents, families, and their caregivers. About two thirds of nursing homes will see a decline in their QM rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating.3 However, the changes in the quality measures star ratings released in February are not indicative to the change in the quality of care provided.4 Meaning, that the star rating may decline, even if the nursing home’s actual performance does not change due to the increased number if data points contributing to the total star rating.
To achieve better care, smarter spending, and healthier residents, the Department of Health and Human Services is focused on sharing information more broadly to providers, consumers, and other to support better decisions while upholding patient privacy.5 It is important that the facility takes a proactive approach by sharing the new QM star rating information with all staff, residents, and consumers. It is also important that the facility educate the public to recognize that the prior year’s star rating is not inclusive of the new data additions added to this year’s star rating. For more information CMS has posted the changes on their website at www.cms.gov or visit www.medicare.gov.
Following the best practices detailed above can help to ensure that a Facility upholds the same high standards and reputation that make it a pillar in the community. If you'd like to learn more, please contact us and visit CMS.
References
Long Term Living http://www.ltlmagazine.com/news-item/cmsannounces-nursing-home-compare-changes
http://www.ltlmagazine.com/news-item/cms-overhaul-5-starnursing-home-rating-system
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2015-Fact-sheets-items/2015-02-12-2.html
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releasesitems/2015-02-20-2.html
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