CMS Announces Changes to Nursing Home Five-Star Quality Rating System in 2015

On October 6, 2014, the Centers for Medicare and Medicaid Services (CMS) announced  that it will implement changes to the Nursing Home Five-Star Quality Rating System in 2015.  CMS launched the five-star system for nursing homes in December 2008.

The current five-star rating for each nursing home is based on the star ratings for three separate categories:  1) health inspections; 2) quality measures; and 3) staffing.  To determine a nursing home’s overall rating, CMS begins with the facility’s health inspection rating and then adds or subtracts “stars” depending on the facility’s staffing rating and its quality measures rating.

CMS will implement the following changes to the Five-Star Rating System in 2015.

Nationwide Focused Survey Inspections:  CMS and states will begin focused survey inspections nationwide in a sample of nursing homes to verify the staffing and quality measure information that is part of the Five-Star Quality Rating System.

Payroll-Based Staffing Reporting:  CMS will use a quarterly electronic reporting system to verify staffing information.  According to CMS, the system can be audited back to payroll to verify staffing information and thus increase the accuracy and timeliness of the data.

Additional Quality Measures:  CMS will increase the number and type of quality measures.  The first new quality measure—usage of antipsychotic medications—will be introduced in January 2015.

Timely and Complete Inspection Data:  CMS will work to ensure that states maintain timely and complete inspection data, including a user-friendly website.

Improved Scoring Methodology:  CMS plans to revise the scoring methodology used to calculate each facility’s quality measure rating, which is one of the three categories used to determine the overall star rating.