Five Star Rating Changes Effective April 2019

This week CMS released upcoming improvements to Nursing Home Compare and the Five Star Rating system that will go into effect in April 2019. Key changes that will take place in April include:

Health Inspection Rating:

  • The freeze on the Health Inspection rating will end
  • Surveys occurring after Nov. 28, 2017 will now be included in the rating
  • Ratings will again be based on three cycles of inspections (the three most recent standard inspections and any complaint inspections occurring within the past three years)
  • The cycles will return to pre-“freeze” weightings, with the most recent period (cycle 1) assigned a weighting factor of 1/2, the previous period (cycle 2) with a weighting factor of 1/3, and the third period (cycle 3) having a weighting factor of 1/6 of the health inspection score
  • Star ratings will not be displayed for Special Focus Facilities

Quality Measures Rating:

  • Separate Quality Measure ratings were created for short-and long-stay measures
  •  Each facility will continue to have an overall QM rating, which will be used to calculate the overall nursing home star rating
  • The overall QM rating will be equally based on the short-stay and long-stay quality ratings
  • Increased thresholds for ratings, based on the rate of improvement on QM scores since the last revision in February 2015.
  • Every six months, QM thresholds will be increased by 50% of the average rate of improvement in QM scores to incentivize continuous quality improvement
  • Individual QMs will be weighted and scored differently
    • High and medium weighting levels established
    • Total number of points available for QMs with high weighting will be 150 points and medium weighing will be 100 points each
    • Points for QMs weighted “high” will be awarded by thresholds established at each decile, whereas points for QMs weighted “medium” will be awarded by thresholds established at each quintile
  • Adding the long-stay hospitalization measure and a measure of long-stay emergency department transfers to the QM rating
  • Short-stay pressure ulcers and successful discharge to community measures are being replaced by the similar measures from the SNF Quality Reporting Program (QRP)
  • Removing long-stay physical restraint measure from QM rating’s calculation, but will continue to report the measure on Nursing Home Compare

Staffing Rating:

  • Adjusted thresholds for staffing ratings to increase the weight registered nurse staffing has on the staffing rating
  • Four days (instead of seven days) without RN onsite will trigger automatic downgrade to one-star Staffing Rating

For more information about the changes described here, please see the “Five- Star Users’ Guide April 2019” in the downloads section of the CMS website.

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