In April 2019, the Centers For Medicare & Medicaid Services (CMS) made several changes to the Nursing Home Compare website and the Five-Star Quality Rating System, which affected all domains of the rating system. CMS published the changes in its “Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide April 2019.”
CMS’ Nursing Home Compare Five-Star Quality Rating System provides “star” ratings for each nursing home so that residents and their families have an easy way to understand assessment of nursing home quality, making meaningful distinctions between high and low performing nursing homes. The rating system features an Overall Quality Rating of one to five stars based on nursing home performance on three domains, each of which has its own rating: (1) Health Inspections – Measures based on outcomes from state health inspections, (2) Staffing – Measures based on nursing home staffing levels, and (3) Quality Measures – Measures based on MDS and claims-based quality measures (QMs).
CMS made the following revisions:
Health Inspection Domain: The rating methodology for the health inspection rating returned to what it was prior to February 2018. Specifically, results from the three most recent standard health inspections and 36 months of complaint inspections are used to calculate the health inspection score and determine the health inspection rating. Surveys occurring both before and after the implementation of the new survey process (November 28, 2017) are used to determine health inspection scores and rating and are treated in the same way;
Staffing Domain: The staffing rating thresholds were changed, with the staffing level required to receive a 5-star rating determined based on analyses of the relationship between staffing levels and measures of nursing home quality. In recognition of the importance of RN staffing, the method by which the RN staffing rating and the total nurse staffing rating are combined to generate the overall staffing rating is changing to provide more emphasis on RN staffing. Additionally, the overall and RN staffing ratings are set to one star for nursing homes that report four or more days in the quarter with no RN onsite. Finally, staffing ratings are no longer being suppressed for nursing homes that have five or more days with residents and no nurse staffing hours reported;
Quality Measures Domain: The Nursing Home Compare website reports separate ratings for short-stay quality of resident care and long-stay quality of resident care in addition to an overall quality of resident care rating. Measures of long-stay hospitalizations and long-stay emergency department (ED) visits were added to the quality measure rating, and the long-stay physical restraints measure was dropped from the quality measure rating. The scoring rules for the quality measures changed to give more weight to measures with greater opportunity for improvement. Given the changes in measures and weights, there are also new point thresholds for the overall quality measure rating as well as the short-stay and long-stay ratings;
Special Focus Facilities: Nursing Home Compare no longer displays an overall quality rating or ratings in any domain for nursing homes currently participating in the Special Focus Facility program.
The revisions, which were published by CMS on April 24, 2019, reportedly resulted in 47% of skilled nursing facilities seeing no change in their rating; 37% experiencing a decline of one or more stars; and, 16% having an increase in their overall star rating.
If you or a loved one suffered injuries (or worse) while a resident of a nursing home in the United States due to nursing home neglect, nursing home negligence, nursing home abuse, nursing home under-staffing, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home claim lawyer in your state who may investigate your nursing home claim for you and file a nursing home claim on your behalf or behalf of your loved one, if appropriate.
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