CMS continues to be focused on staffing as a key element in nursing home quality and safety. The new QM thresholds (listed below) used higher cut points than in the past, resulting in ratings decline.
On the positive side, 1,098 facilities moved up at least one star. A total 2,314 facilities dropped at least two stars. Additionally, 2,359 previously five or four-star ratings dropped to a three-star. The largest jumps were 2,298 five-star ratings falling to a four-star, which also caused many facilities to lose the positive +1 quality bonus. Overall, changes to the quality domain resulted in a net of 7,265 facilities losing at least one star. The data shows that quality domain had the most significant impact on ratings, followed by the staffing domain, and then health inspections. Quality and staffing domain changes drove the redistributions.Ĭory Rutledge, Principal, CLA Star ratings impact by domainīy looking into the domains, we can better understand which changes had the largest impact. Our analysis reveals the largest impacts were to the top and bottom ratings, where there were fewer five-star facilities and more one-star facilities. However, these changes have resulted in a more even distribution of facilities among the stars. In addition, 1,210 fewer facilities held the highest ranking of five stars. Overall, 53 percent of all facilities’ stars ratings were impacted under the new change.įollowing CMS’ changes, 1,159 additional facilities dropped to the lowest ranking of one star. Under the new methodology, 2,387 nursing homes increased their ratings by one or more stars, while 5,550 lost at least one or more stars. Using CLA Clarity to dissect the impact of these changes, we found a total of 7,937 nursing homes’ ratings were positively or negatively impacted. The overall impact of these changes resulted in considerable shifting within the star ratings for skilled nursing facilities (SNFs). Overall impact of star ratings on nursing homes
CMS lowered the threshold from seven to four days. Previously, a facility with no RN on site for seven days or more received an automatic downgrade to one star in the staffing domain rating. The previous requirement began in 2018 and uses Payroll Journal Reporting (PBJ) for a more accurate look at facility staffing requirements. CMS made a key change to the staffing domain with respect to the number of days without a registered nurse (RN) on site. CMS is also adding a long-stay hospitalization measure and a long-stay emergency department (ED) transfer measure to the rating system, among several other measure changes. Thresholds for ratings will be updated every six months, as well as weighting and scoring individual QMs differently. The agency will use a separate measure rating for short or long stays to reflect the level of quality provided for these two subpopulations in nursing homes. CMS made multiple changes to the quality measures (QM) domain. While the guidance goes beyond nursing homes to cover all Medicare and Medicaid entities, it is still relevant for star quality ratings. Additionally, in a separate memorandum, CMS provided new guidance to state surveyors on “immediate jeopardy” findings. Inspections occurring on or after November 28, 2017, are included in each facility’s star rating. The agency decided to end the freeze on health inspection star ratings and resume the traditional method of calculating these scores by using three cycles of inspections. During the transition, CMS temporarily held constant (or froze) the health inspection star rating for nursing homes for roughly a year. In 2017, CMS implemented a new inspections process. CMS star rating changes effective April 1ĬMS made key changes to the Five-Star Quality Rating program, including updates to these domains: By highlighting some of these swings, we can better evaluate the cumulative impact of CMS’ updates. Since the changes have taken effect, we have analyzed swings within specific domains as nursing home ratings rise and drop based on the new criteria.
#CMS NURSING HOME COMPARE FIVE STAR RATINGS OF NURSING HOMES FULL#
With the recent release of CMS’ Nursing Home Compare quarterly data, the full impact of these updates can now be assessed. While some nursing homes may have missed the announcement about Centers for Medicare and Medicaid Services (CMS) updating the Five-Star Quality Rating System methodology beginning April 1, it would be difficult to ignore it now.
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