CMS Is Leaving Us Asking: What Pain?

The Centers for Medicare and Medicaid Services (CMS) has announced that as of the October Nursing Home Compare refresh (Oct. 23, 2019), they are removing both the long- and short-stay pain quality measures (QM) from the calculation of the Five-Star QM domain. Below is a comparison of the cut point ranges pre- and post-pain measures removal. For each QM rating, points scored for Long-Stay, Short-Stay, and Overall are given for both prior to removal of these measures (Sept. 30, 2019) and after removal (Oct. 1, 2019). The points in red represents CMS’s adjustment to the cut point ranges. For the Long- and Short-Stay measures (Percentage of Residents Who Self-Report Moderate to Severe Pain), nursing homes are grouped into quintiles to score a minimum of 20 points, increasing in increments of 20 to a maximum of 100 points.

How to use this calculator:

Go to your Five-Star Analysis Report link emailed in July. If you are a Quality Apex subscriber, log in to Quality Apex and click the “Get The Report” link. Once in the report, scroll down to the QM domain and find both of the pain measures, the points scored for each measure, and the QM rating points scored. Subtract the points scored on the QM from the QM rating score to get the difference, then go to the table and locate the difference score to project how the removal of pain measure points could affect your October QM domain rating.

For example:

Facility X had a 5-star long-stay QM rating in September for a score of 1,250 points. They were receiving 100 points for their long-stay pain measure. In October, they would lose 100 points from their long-stay QM rating, leaving a difference score of 1,150. Find 1,150 in the table: QM Rating column – row 5 Star, Long-Stay QM column – row 10/1/19. This means that Facility X would maintain a 5-star rating for their long-stay QM domain.

However, change the example to the following: Facility X had a 5-star long-stay QM rating in September for a score of 800 points. They were receiving 100 points for their long-stay pain measure. In October, they would lose 100 points, leaving a difference score of 700. Find 700 in the table: QM Rating column – row 4 Star, Long-Stay QM column – row 10/1/19. This means that Facility X would lose a star in their long-stay QM rating. If this facility were relying on their QM domain to add a star to their overall rating, that could be lost too.

The updated Five-Star Quality Rating System Technical Users’ Guide can be found here.

For questions about using this tool, contact Susan Chenail at 518-867-8846 or schenail@leadingageny.org.

Contact: Susan Chenail, schenail@leadingageny.org, 518-867-8846