Healthcare Landscape

Five-Star Quality Rating System

The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System to assist consumers, families, and caregivers with an easy comparison of nursing homes.  Changes to the system will be implemented in April 2019.

The Background

In December 2008, CMS enhanced its Nursing Home Compare public reporting website to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid. The ratings take the form of stars from 1 (lowest rating) to 5 (highest rating) for each nursing home in three domains:

  • Health Inspections
  • Staffing
  • Quality of Resident Care Measures

The Centers for Medicare & Medicaid Services (CMS) calculates a star rating for each of these three sources, and provides an additional overall rating.  The star ratings can be compared side by side to other nursing homes.

The April 2019 Changes

For the Health Inspection domain, results from the three most recent standard health inspections and 36 months of complaint inspections will be used to calculate the health inspection score and determine the health inspection rating.

For the Staffing domain, the staffing rating thresholds are changing.  The staffing level required to receive a 5-star rating will be based on analyses of the relationship between staffing levels and measures of nursing home quality.

Ratings for the Quality of Resident Care Measures domain will continue to be based on performance of 17 quality measures (QMs) that are currently posted on the Nursing Home Compare website. These include ten long-stay measures and seven short-stay measures.  For this domain, the Nursing Home Compare website will report separate ratings for short-stay quality of resident care and long-stay quality of resident care, in addition to an overall quality of care rating. Measures of long-stay hospitalizations and long-stay Emergency Department (ED) visits are being added to the Quality of Resident Care Measures rating, and the long-stay physical restraints measure is being dropped.

For currently reported Special Focus Facilities, the Nursing Home Compare will no longer display overall quality ratings or ratings in any domain for nursing homes currently participating in the Special Focus Facility program. 

Partnering with Paragon

The primary goal of the Five Star Quality Rating System is to provide a “snapshot” of the quality of each nursing home so that residents, consumers, families, and the public have an easy way to understand assessment of nursing home quality and the ability to make informed comparisons.

Paragon Rehabilitation can assist with improving ratings by collaborating with campus teams to ensure each resident is receiving the highest possible quality of care.  Therapy screenings, home assessments, and consistent, ongoing interdisciplinary communication are paramount.  Focus on quality measures as indicators of possible problem areas, provision of quality care with report of  functional outcomes, and care practices that honor each resident’s rights, preferences, needs, and priorities can promote better outcomes with health inspections and enhance the rating for the campus while improving quality of life for our residents.

For more information, visit https://www.medicare.gov/NursingHomeCompare/compare and https://www.cms.gov.

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