October 2019 Changes to Nursing Home Compare and Five Star Rating

The Centers for Medicare and Medicaid Services (CMS) issued two QSO memos on Monday, October 7, 2019. The second QSO memo, “Updates to Nursing Home Compare website and the Five Star Quality Rating System,” is not receiving as much attention as the first, which addresses consumer alerts on Nursing Home Compare for facilities that have been cited for abuse. The second memo includes important information that should not be overlooked.

Quality Measures Updates

Two Quality Measures are being removed from the Five Star Quality Rating calculation and Nursing Home Compare. These include the Short-Stay and Long-Stay QMs for residents who report moderate to severe pain. CMS is removing these measures to ensure that nursing facilities do not try to address their facilities’ QM for pain by administering opioid medications and thus contributing to the Opioid Crisis.

Quality Measure Thresholds Changing in April 2020

As CMS mentioned in previous updates regarding Nursing Home Compare, Quality Measure thresholds will be increased by 50% of the average rate of improvement in a QM score every six months to incentivize continuous quality improvement in nursing homes. This may result in some providers seeing a decline in their Five Star ratings due to the calculation methodology.

View the CMS QSO Memo, “Updates to Nursing Home Compare website and the Five Star Quality Rating System” (Ref: QSO-20-02-NH) here.

An updated Five-Star Quality Rating System Technical User’s Guide has also been published. The file, titled “Five-Star Users’ Guide October 2019” was added on October 8, 2019. The first page currently still has an April 2019 date on it, but includes a section for “October 2019 Revisions” at the beginning of the document. These revisions include:

  • Ratings changes for facilities that receive the abuse icon – Nursing homes that receive the abuse icon will have their Health Inspection rating capped at a maximum of two stars. The guide states that due to the calculation methodology, the maximum Overall Rating that a facility can receive will be four stars.
  • Quality Measures that are being removed related to Pain – The cut points for Long-Stay/ Short-Stay and Overall QM ratings will be changing, but the intent is to try to maintain the same distribution of LS and SS QMs ratings that have been posted since July 2019.

Download the updated Technical Users’ Guide here.

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