Kusserow on Compliance: CMS changes five star quality rating for nursing homes

CMS has made changes to the Five Star Quality Rating System for nursing homes on the Nursing Home Compare (NHC) website. CMS rates nursing homes based on three categories: (1) onsite inspection results from trained surveyors; (2) performance on quality measures; and (3) levels of staffing. The changes to the nursing home star rating system include:

  • Inclusion of two new quality measures related to the use of antipsychotic medication since these drugs are often employed for diagnoses that do not warrant their use;
  • Improved calculations of nursing home staffing levels by adjusting staffing algorithms;
  • Recalibration of quality standards requiring nursing homes to achieve a higher standard for a higher rating on the quality measure dimension; and
  • Expansion of targeted state surveys to conduct specialized, onsite surveys of a sample of nursing homes to assess adequacy of resident assessments and accuracy of information reported to CMS used in calculating quality measures for the rating system.

In its press release on the subject, CMS predicts that approximately two-thirds of nursing homes will experience a decline in their quality measures star rating and approximately one-third of nursing homes will experience a decline in their overall five star rating. It is expected that this will be the result of new increased standards for performance on quality measures. Currently, about half of nursing homes will receive a 4 or 5 star rating as their quality measure rating, versus 80 percent of nursing homes in the previous period. CMS’ changes to the NHC website include more meaningful distinctions in performance and aim to incentivize nursing homes to continuously improve care.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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