*Information coming soon on Proactive’s 2020 5-Star Insights webinar series focused on helping your facility achieve or maintain 5 Star in 2020. Make plans to join us beginning in March!

Easier for Consumers to Identify Facilities with Instances of Non-compliance

On October 7, 2019, CMS announced additional changes to the Five-Star Quality Rating System that will be implemented in October 2019. An “abuse icon” will be added to facilities cited for abuse to make it easier for consumers to identify facilities with instances of non-compliance related to abuse, the two pain quality measures will be removed from the quality measure rating, and there will be new cut-points for the overall quality measure rating.

Abuse indicator

Starting October 23, a “Do not proceed” consumer alert icon will be added to facilities cited for abuse at scope/severity of G or higher on the most recent standard survey or on a complaint survey within the past 12 months and/or facilities cited for abuse at scope/severity or D or higher on the most recent standard survey or a complaint survey within the past 12 months and on the previous standard survey (second most recent) or on a complaint survey in the prior 12 months (12-24 months ago). CMS is also updating a consumer checklist with questions that consumers can use to ask facilities for information about how they prevent abuse.

Nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that has received the abuse icon can have is four stars.

Removal of Quality Measures related to Pain

Both the Percentage of short-stay residents who report moderate to severe pain and the Percentage of long-stay residents who report moderate to severe pain will be removed from the Nursing Home Compare Website and the Five Star Quality Rating System in October 2019. This change is in response to the severity of the Opioid Crisis, in an attempt to “avoid any potential scenario where a facility’s performance on the pain quality measures may inappropriately contribute to their decision to seek the administration of an opioid” (CMS, 2019).

As a result of dropping these two pain measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting in October. These changes will be made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. The new cut-points can be found in the Five-Star Quality Rating System: Technical User’s Guide, which was updated September 2019 with a description of changes that will be made in October 2019.

Increase of Quality Measure Thresholds

As part of the April 2019 changes to the Five Star Quality Rating System, CMS announced they would be increasing the thresholds for quality measures (QM) every six months in an effort to drive continuous quality improvement and to help prevent larger threshold adjustments on an unscheduled basis. In response to this, in April 2020, CMS will begin increasing QM thresholds by 50% of the average rate of improvement in QM score, and will do so every six months. For example, if there is an average rate of improvement of 4% in a QM, the QM threshold would be increased by 2%. As CMS changes the QM thresholds, some facilities will see a decline in their rating in these areas until further improvements are made in that area and this may result in a decline in their overall five star rating.

Change in Nursing Home Compare Update Schedule

Due to upcoming holidays, the nursing home compare website will not be updated on the normal schedule of the last Wednesday of the month. The dates of scheduled updates for the next few months are:

  • October 23, 2019
  • December 4, 2019
  • January 29, 2020

Beginning in February 2020, updates will continue to be made on the last Wednesday of the month.

Proactive Medical Review specializes in assisting facilities with Five-Star Rating Improvement plans and preparing providers for the new LTC Survey Process. Contact us today for more information regarding our proven Five-Star Improvement partnerships and survey preparedness projects.

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Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review

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