CMS Changes Have Nursing Homes Seeing Falling Stars

In a recent press release, the Centers for Medicare and Medicaid Services (CMS) revealed that their estimates for the number of nursing homes that had Five Star ratings of 4 or 5 stars was approximately 80 percent of all nursing homes nationally, and estimated a fall to about 49 percent. Two-thirds of nursing homes nationally were expected to decline in the Quality Measure (QM) domain rating, with approximately one-third expected to decline in the overall star rating.

The following chart depicts the percentage of New York facilities with changes to the five star rating based on the new methodology.  

Note: Of the 84 not-for-profit and government-owned nursing homes that declined in their overall rating, 76 facilities declined 1 star, 7 declined 2 stars and 1 declined 3 stars. Of the 128 for-profit nursing homes that declined in their overall rating, 119 declined 1 star and 9 declined 2 stars. 

According to the CMS issued guidance, S&C: 15-26-NH, many nursing homes will initially see a decline in their QM rating, and some nursing homes will experience a decline in their overall Five Star Rating. The guidance further clarifies, however, that a decline in a nursing homes’ rating does not necessarily represent a decline in quality. The changes could be related to the new measures that have been added for antipsychotics, or could be related to the new cut point methodology used for the overall QM rating.   

The two primary changes in the methodology that are resulting in the falling stars are the staffing rating and the quality measure cut point changes. These changes are detailed in the Five Star Technical Users’ Guide.

• Staffing: The staffing rating is based on two ratings, "RN" and "Total Nursing." The two ratings are combined for an overall staffing rating. Prior to the changes, one of the ratings could be below 4 or 5 and the other above, and the overall rating would be at least a 4. With the new changes, both ratings must be at least 4 to obtain an overall rating of 4.
• Quality Measures: The quality measures each previously received a rating from 1-99, and then the total was compared to a scale for an overall rating. The ratings now received points based on quintiles, with the point distributions in increments of 20 (20, 40, 60, 80, 100 points). In addition, two new antipsychotic measures were added, and the scale for the overall rating was updated, needing an overall sum of at least 760 points to obtain five stars, instead of the previous 616 points.  

LeadingAge New York’s ProCare consulting division has been performing quality metric evaluations for several member facilities for the Five Star and NYS Quality Pool rating systems. If you need assistance understanding what is driving your numbers or developing an individualized action plan to raise your rating, ProCare can help. 

Contact: Michelle Synakowski, msynakowski@leadingageny.org, 518-867-8850.