CMS Changes Nursing Home Rating System

The Centers for Medicare and Medicaid Services (CMS) announced that it will reveal its new Nursing Home Compare 5-Star Quality Rating System to the public on February 20, 2015.   CMS will change its ratings to raise the bar for achieving a high rating in the Quality Measures category.  Thus, ratings will likely fall for many nursing homes even though there has been no change in the quality of care.

CMS is raising the standards for nursing homes to achieve a high rating in the Quality Measures category by increasing the numbers needed to achieve a particular star category.  According to CMS, in 2008 the initial scoring for the Quality Measures rating was set at a distribution that reflected the status quo with the expectation that there would be progress and changes to the quality measures thresholds over time.  When nursing homes have made progress in raising performance standards, CMS resets the distribution to promote further progress.

In addition to raising performance expectations, CMS is making the following changes to the 5-star rating system:

  • Additional Quality Measures:  CMS added two additional quality measures for antipsychotic medication use in nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
  • Staffing Algorithms:  CMS adjusted these measures to more accurately reflect staffing levels.
  • Survey Expansion:  CMS announced a plan for State Survey Agencies to conduct specialized, onsite surveys of a sample of nursing homes in the country to assess the adequacy of resident assessments and the accuracy of information reported to CMS that is used to calculate quality measures.

These changes to the 5-Star Quality Rating System are the third major revision to the Nursing Home Compare website since it was launched in 1998.  CMS says that a fourth change is scheduled for 2016.

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.