Changes to Nursing Home Star Ratings Are Here

Beginning this month, the Centers for Medicare & Medicaid (CMS) is changing its star ratings on Nursing Home Compare and its Five-Star Quality Rating System, which allows consumers to compare quality between nursing homes.

CMS says the updates “reflect more transparent and meaningful information about the quality of care that each nursing home is giving its residents.â€

The changes, which are expected to go into effect by mid-April, include revisions to the inspection process, enhancement of new staffing information and implementation of new quality measures.

As part of those changes, CMS will lift the freeze it imposed on health inspection ratings it put into place in February 2018. That freeze put a hold in each facility’s health inspection rating, during which inspections conducted after November 28, 2017 were not included in the facility’s star ratings calculation. The freeze was due in part to the agency’s implementation of a new inspection process. CMS said it didn’t want to rate nursing homes on health inspections until all of them were assessed at least once under the new survey – giving everyone a level playing field.

In addition, CMS is setting higher thresholds and evidence-based standards for nursing homes staffing levels. CMS found that as staffing levels increase, quality increases. As a result, nursing homes that report no registered nurse onsite will be assigned an automatic one-star rating. CMS also is changing its ratings based on the number of days a registered nurse is required to be onsite. Currently, nursing homes that report seven or more days in a quarter with no RN onsite are automatically assigned a one-star staffing rating. In April, the trigger will be reduced from seven to four days.

CMS also is introducing separate ratings for short- and long-stay measures to reflect the level of quality provided and is adding the long-stay hospitalization measure and a measure of long-stay emergency department (ED) transfers to the rating system.

The five-star system was adopted in 2008 and comprises three rating domains: health inspections, staffing, and quality measures. Changes and updates have been made along the way.

CMS notes that as a result of changes to the thresholds and methodology for performance on both the Quality Measures and Staffing domains, many nursing homes will see a decline in their rating in these areas until they make further improvements, while others may see an increase.