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April 2019 Nursing Home Compare & Five Star Changes

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a press release, “CMS Improving Nursing Home Compare in April 2019” and alongside that, issued a new QSO memo that details all the changes to Nursing Home Compare and the Five Star Rating System that will be occurring. We provided an overview of the changes that will be occurring related to nursing home inspection ratings, staffing and QMs and will be providing further detail in this post. CMS notes that based on the changes listed, “many nursing homes will see a decline in their rating” in the Staffing and QM domains until they make improvements, including their overall star rating.

Health Inspection Ratings

As we mentioned in our prior post, CMS had frozen health inspection star ratings under the LTCSP in February 2018. CMS found through its analysis that under the LTCSP, there are slightly more deficiencies being given than under the prior survey process, but that this is in line with the increased regulatory expectations under the RoPs. This rating will be unfrozen in April 2019, but that’s not all:

  • Health inspection ratings will be based on 3 cycles of inspections again (Most recent 3 standard surveys and any complaints within the past 3 years).
  • Pre-freeze weights for survey cycles will become effective – Cycle 1 will be weighted as ½, Cycle 2 will receiving a weighting of 1/3 and Cycle 3 will have a weighting of 1/6 of the health inspection scores
  • Special Focus Facilities (SFF) – Facilities designated as Special Focus Facilities will have their star ratings suppressed on Nursing Home Compare

Staffing Updates

Changes are also coming to the staffing rating domain. The staffing rating grid will be adjusted to increase the weight of RN staffing on the staffing rating. As we mentioned in our prior post, the threshold number of days without an RN on site is being reduced from 7 to 4 – facilities reporting 4+ days will no RN on-site during a quarter will be automatically assigned a 1-star staffing rating.

Quality Measures

As we mentioned yesterday, updates to the Quality Measures rating will also be made, but here are the specifics.

  • Ratings for short-stay and long-stay ratings are going to be split into two groups with separate QM ratings. Facilities will continue to have an overall QM rating that will be used for the overall star rating based equally on short-stay and long-stay ratings.
  • QM thresholds to see continuous increases – CMS is adjusting the ratings thresholds for QMs, and will be raising QM thresholds every 6 months to encourage and incentivize continuous quality improvement. The thresholds will be increased by 50% of the average rate of improvement in QM scores.
  • Two weighting levels for QMs are being put into place – high and medium – which will reflect clinical significance and room for improvement. High weighted QMs can get a total of 150 points each and medium weighted QMs can get 100 points each.
  • QMS being added – Long-stay hospitalizations QM and Long-stay emergency department transfers will be added to Nursing Home Compare and the rating system.
  • QMs being replaced – Short-stay pressure ulcers and Short-stay successful discharge to the community QMs are being replaced with measures from the SNF QRP Program.
  • QM being removed –  Long-stay residents who were physically restrained is being removed from the rating system but will still be reported on Nursing Home Compare.

Read the March 5, 2019 QSO Memo, “April 2019 Improvements to Nursing Home Compare and the Five Star Rating System” (Ref: QSO-19-08-NH).

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