For facilities that have relied upon the strength of their staffing rating to drive the overall Five Star rating, the new guidance effective with the July 2022 refresh is estimated to negatively impact 10-16% of providers, according to a July 11 McKnight’s report (7/11 Marselas.)
Changes to the Methodology for the Overall Quality Rating
Effective with the July 2022 refresh, CMS is revising the methodology for assigning the overall quality star rating. Previously, facilities that obtained a four- or five-star staffing rating, received an additional star in their overall star rating. Effective July 2022, only nursing homes with a five-star staffing rating will get an increase in their overall star rating. The full methodology for assigning the overall quality star rating based on the health inspection rating, the staffing rating and the QM rating is described in the Overall Nursing Home Rating section below.
Changes to the Methodology for the Staffing Rating
Effective with the July 2022 refresh, CMS is revising the methodology for calculating the Staffing star rating. The new rating is based on six separate staffing measures. Similar to the Quality Measure (QM) rating, points are assigned based on the performance on each of these six measures. The points are then summed and the total staffing score is compared to staffing rating point thresholds to assign a rating of one to five stars. The six measures are as follows:
- Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day)
- Case-mix adjusted RN staffing levels (hours per resident per day)
- Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day) on the weekend
- Total nurse turnover, defined as the percentage of nursing staff that left the nursing home over a twelve-month period
- Registered Nurse (RN) turnover, defined as the percentage of RN staff that left the nursing home over a twelve-month period
- Administrator turnover, defined as the number of administrators who left the nursing home over a twelve-month period.
Details on the definition of each of these measures and how the staffing rating is calculated based on facility performance on these measures are provided in the Staffing Domain section of the updated Five-Star User’s Guide. (Note that significant changes are identified in red, italicized text).
The table below indicates the staffing star rating that will be assigned based on the total points received for each measure.
Facilities can use Appendix Table A2 in the updated Five-Star User’s Guide to determine how many points you will receive for each measure. Performance for each measure that will be used for the July 5-Star update can be found in your facility’s June 5-Star Preview report, which was posted in your CASPER folder on June 17th. To access this report, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the ‘Folders’ button, then select ‘My Inbox’ or the Inbox beginning with ‘LTC’ and the state abbreviation followed by a facility ID.
What this means for my facility
Due to the addition of weekend staffing and turnover measures impacting the 5-star staffing rating, many facilities will experience a decline in their staffing rating, despite having similar levels of staffing as in the previous quarter. For example, a facility reviewed that would have been a 3-Star for staffing (based on RN and total staffing for quarter 1 of 2022) prior to this change to the methodology for the staffing rating, will now be a 1-Star for staffing based on the new methodology for the staffing rating.
