Prepare for Changes to CMS’ Five Star Quality Rating System for Nursing Homes

Posted by Health Law Informer Author on October 10, 2014
CMS, Medicare

Choosing a nursing home can be a daunting task for consumers who often have myriad questions regarding the quality of care available at the nursing homes in their areas. To help answer these questions, CMS has created the Nursing Home Compare website, which provides consumers with easy-to-compare ratings of nursing homes’ staffing, quality measures, and health inspections, as well as an overall rating, of each nursing home in the country. To help consumers make informed decisions about nursing home quality, CMS uses the Five Star Quality Rating System, by which CMS compares data from nursing home inspections, self-reports, and assessments.  Based on this information CMS calculates nursing homes’ star levels on a scale of one to five, with five stars being much above average and one star being much below average.

However, there has been concern over the accuracy of the self-reported data that CMS uses in calculating its star ratings. To improve the Five Star Quality Rating System, and to standardize the results, Congress recently passed the Improving Medicare Post-Acute Care Transformation Act (“IMPACT Act”). The IMPACT Act will require providers to submit standardized data to allow CMS to compare quality across different post-acute care settings, and will provide funding for the quarterly electronic submission of nursing home staffing information that is tied to payroll data. CMS will also increase both the number and type of quality measures used in the Five Star Quality Rating System. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are in use. Future additional measures will include claims-based data on re-hospitalization and community discharge rates.

According to CMS, the following improvements to the Five Star Quality Rating System will be made beginning in 2015:

  • Upgraded user interface to ease navigation and improve the clarity of key metrics for both online and printable formats.
  • Revised scoring methodology by which CMS calculates each facility’s quality measure rating, which CMS uses to calculate the overall Five Star rating.
  • Increased number and type of quality measures that are not solely based on self-reported data. This makes the rating system less susceptible to the manipulation of a few measures, and provides a more comprehensive assessment of the quality of care nursing homes provide.
  • Improved linkage to state-based websites for improved access to information that is uniquely reported by individual states.
  • Improved reporting on nursing home staffing that increases the accuracy of data for staffing levels and adds other critical measures such as turnover and retention.

Practice Tip: The IMPACT Act will reduce Medicare’s payment rates for services furnished by skilled nursing facilities that do not report assessment and quality data, so make sure that your facility is ready to make reports in accordance with the IMPACT Act’s timelines.

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