The Big Thaw: Five-Star Update

CMS is “thawing out” the freeze on Five-Star Ratings effective April 2019. We were all expecting the thaw this spring, and CMS doesn’t disappoint! Remember that spring showers bring May flowers, and for some of you, “flowers” will take the form of an improvement in your Five-Star Rating.
CMS did more than just unfreeze the Five-Star Health Inspection ratings as anticipated. Let’s review some additional updates.
  • Health Inspection (HI)

    The Health Inspection (HI) domain will now include survey points “earned” on or after November 28, 2017. The HI Five-Star rating will revert to the original three-survey cycle calculations and 36 months of complaint inspections. The weighting for the three survey cycles also reverts to previous weighting factors (Cycle 1 -1/2 (50%), Cycle 2- 1/3 (33.33%), and Cycle 3- 1/6 (16.66%), instead of the current 60% (Cycle 1) and 40% (Cycle 2).
  • Special Focus Facilities (SFF)

    Special Focus Facilities (SFF) will have no star ratings for Overall as well as the three domains. Currently an SFF would show a star rating but would be capped at three stars overall. This is being taken away with the latest changes: beginning in April, a yellow “warning” icon will be displayed instead, and “Not Available” displayed for all the other domains (essentially, the eye will see no star ratings).
  • Registered Nurse (RN) Staffing

    Registered Nurse (RN) staffing HPRD given increased weight in the overall Staffing star calculation (we expected this change, right?). Additionally, the threshold has been lowered for the number of days with no reported RN staffing from seven days in the quarter to four days, (makes sense since ongoing Payroll Based Journal (PBJ) data being submitted-increased transparency into staffing patterns).  Facilities reporting four or more days without RN 8+ hours onsite will receive a 1-star Staffing rating (the take awayFacilities with fewer RNs on staff will need to ensure daily RN coverage or risk their Overall rating).
  • New Quality Measures

    Two new claims-based Quality Measures (QM) were added: Long-Stay Hospitalizations and Long-Stay Emergency Department Visits. CMS introduced separate star rating calculations for Short Stay and Long Stay Quality Measures. This is in addition to the overall QM Domain Star rating (the overall QM domain rating will be equally based on SS and LS quality ratings).  Each individual QM will be weighted and scored differently.  CMS established two different weighting levels for scoring: medium and high.  The thresholds for the ratings will be regularly updated every six months.
  • QM Removed

    And finally, so to speak…Long-Stay Physical Restraints QM is taken out… (although will still be reported in Nursing Home Compare (NHC) but not included in the Five-Star QM Domain calculations).

Spring Has Sprung – Now What?

April is regarded as a month of renewal, when flower buds begin to sprout and eventually bloom into magnificent beauties, that is if you have a green thumb! Seriously though, in anticipation of constant change to our regulatory landscape and what faces us in the upcoming weeks, are we ready as we await our Five-Star Rating? What will our stars disclose? What is looming down the road may be challenging at best, but we can look forward to the revival that change brings whether we have a green thumb or not!

More Information

For more specific details about the Five Star Changes Please refer to Five-Star Quality Rating System: Technical User’s Guide April 2019.