Insight: 5-Star Rating Updates Announced

Quality Ratings At The Heart Of Healthcare

As you know, back in 2008 CMS created the Five-Star Quality Rating System to the Nursing Home Compare site to help consumers, their families, and caregivers compare nursing homes more easily, especially in the quality of care delivery. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one overall 5-star rating for each nursing home, and a separate rating for Health Inspections , Staffing  and Quality Measures (QMs).

5.

Key Take-Aways From The 2/12/15 ODF:

I had the opportunity to listen in on the CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum (ODF) held on Thursday, February 12, 2015.  CMS announced the BIG CHANGES related to the following:

– Skilled Nursing Facility 5-Star Rating/Nursing Home Compare  – New Release will be titled – Nursing Home Compare 3.0.  These changes are anticipated to potentially cause the majority of skilled nursing facilities to potentially receive lower star ratings, without any concurrent drop in quality of services. During the call, CMS declined to provide the actual percentage or the number of facilities that will be affected by these changes.

– MDS 3.0 RAI Manual – Read more

 

Changes Announced:

– The new 5-Star ratings will be made public (Go Live) on 2/20/15.

– There are two new Antipsychotic measures (Long Stay Off-Label use of Antipsychotics and Short Stay Off-Label use of Antipsychotics.)

– All other QMs will remain, thus increasing the total QMs used to set a facility’s QM star rating will increase from 9 measures to 11 measures.

– Resetting or rebasing of the Quality Measure (QM) scale – this raises the standard for all SNF on the quality measure dimension. In essence CMS is rescaling the specific cut points (“fixed numeric scores”) of data used to determine star ratings for the new reported Quality Measures. This will have a dramatic impact on skilled nursing facilities QM score – with potential dropping of  one to two stars in the quality measure domain.

– Staffing dimension – new data calculations/algorithms are in place rely heavily on Registered Nurse (RN)  level calculation.  This will make it a little difficult to achieve a higher score unless a facility has RN staffing in alignment with the other staffing areas.  Per CMS “3 Stars of one area + 3 Stars for another area cannot =  an overall 4 star rating .”  Providers need to review their data closely.

– CMS also announced a pilot program  in which skilled nursing facilities are submitting their staffing data via their payroll system.  This program is anticipated to be in place for ALL providers by the end of 2016!

5.

Pathway Health Quality Tips:

– IMPORTANT – TODAY (2/13/15) mid-morning, each facility will be able to review what their new 5-Star rating based upon the new QM and rating system via the CASPER/QEIS system.

– Review the new Technical User Guide available to facilities.

– Providers are encouraged to review their updated 5-Star rating score as all facilities will be affected by this “rebasing” of National data.

– Contact us to complete Clinical Systems Review to provide further insight into your 5-Star rating score and ensuring quality outcomes. 

Learn more.

 

These updates emphasize the importance of developing, implementing and assessing the focus on quality throughout your entire clinical systems. This focus will not only improve your 5-Star rating scores, but quality outcomes of those you serve. 

Remember to keep quality in the heart of all you do!

Resources:

 

Lisa

 

Lisa Thomson
Chief Marketing and Strategy Officer
Pathway Health