Updated 5 Star Ratings Released with Unfrozen QMs! What You Need to Know

Updated 5 Star Ratings Released with Unfrozen QMs! What You Need to Know

CMS has officially released the January 2025 Five-Star Quality Rating updates on Care Compare, and providers across the country are reviewing their new ratings. The January 2025 Care Compare refresh brings significant updates with the introduction of new data for four key quality measures. These changes stem from the transition away from Section G and the adoption of Section GG items, affecting how resident function and care quality are evaluated.

What’s Changing?

The following previously frozen quality measures have been updated using the revised calculation with section GG tasks:

• • Percent of Residents Who Made Improvements in Function (SS) (CMS ID: N037.03) → Now Discharge Function Score (CMS ID: S042.02)
  • Percent of Residents Whose Ability to Move Independently Worsened (LS) (CMS ID: N035.03) → Now Percent of Residents Whose Ability to Walk Independently Worsened (LS) (CMS ID: N035.05)
  • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (LS) (CMS ID: N028.02) → Now Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (LS) (CMS ID: N028.04)
  • Percent of High-Risk Residents with Pressure Ulcers (LS) (CMS ID: N015.03) → Now Percent of Residents with Pressure Ulcers (LS) (CMS ID: N045.02)

Impact on Scoring and 5-Star Ratings

Analysis shows some notable shifts in performance with the replacement of the Section G related items with the GG items. For the following three measures performance has declined when compared to previous measures:

• • Discharge Function Score (CMS ID: S042.02)
  • Percent of Residents Whose Ability to Walk Independently Worsened (LS) (CMS ID: N035.05):
  • Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased (LS) (CMS ID: N028.04):

The only measure that did not decline but instead showed improvement is the percent of Residents With Pressure Ulcers (LS) (CMS ID: N045.02.

The three measures showing an overall decline in performance are directly impacted by the transition in the calculation of the measure from utilizing tasks coded in section G of the MDS to similar tasks coded in section GG, As a result it likely this shift in performance is related to the facility’s efforts to navigate the complexities of the functional assessment and data collection to code the GG tasks that were previously required only on the Medicare assessment types rather than a reflection the quality of care provided, To accommodate for these changes CMS has recalibrated the cut point scores to maintain an even distribution of scores across facilities. This adjustment results in fewer points required to achieve a comparable star rating.

What This Means for Your Facility

While the recalibrated cut points are designed to ensure that the distribution of star ratings remains stable, the underlying metrics are new and require focused attention to maintain an accurate and competitive Five-Star rating.

Proactive Strategies to Stay Ahead:

✔ Review your facility processes for completion of the functional assessment and supportive documentation for all residents

✔ Given the key differences between section G and section GG, validate the facility’s documentation tools support the information needed for coding GG tasks.

✔ Provide ongoing competency-based training for the staff responsible for the completion of the documentation related to functional status.

✔ Review your facility’s performance on the new GG-based measures.

✔ Conduct audits to ensure MDS coding accurately depicts the usual functional level and is supported by documentation during the assessment window.

✔ Enhance therapy and functional improvement programs to address mobility and ADL declines.

✔ Utilize QAPI initiatives to track trends and drive targeted improvements.

✔ Ensure proactive care planning to minimize avoidable declines in function.

Next Steps:

Get Expert Guidance – Navigating these changes requires a strategic approach. Proactive LTC Consulting offers Five-Star audits, regulatory, and quality improvement solutions to help you optimize your ratings.

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