Upcoming Changes to Care Compare & Five-Star Quality Rating System

The Centers for Medicare & Medicaid Services (CMS) announced in a January 7, 2022 QSO Memo that additional information about nursing home staffing is going to be added to the January 2022 Care Compare refresh. Nursing home providers have been submitting their staffing data to the Payroll-Based Journal (PBJ) System for several years now, so it’s no surprise that the level of detail being provided to CMS would eventually be used for the public-facing Care Compare site. Since then, CMS has used the data to highlight facilities with low weekend staffing and direct survey teams to conduct visits on weekends, change the Staffing rating calculation for the Five-Star Quality Rating to weigh Registered Nurse (RN) hours more than other staff, and to update the staffing rating methodology with increased thresholds. Now, despite the fact that the long-term care industry is experiencing more significant issues than possibly ever, the Agency has indicated that it is going to add even more staffing information to Care Compare. These updates will also impact the Five-Star Quality Rating calculations starting this summer.

What’s Being Added

First, CMS will be adding information about weekend staffing. It has long been reported and observed that there can be variability in staffing levels on weekends. Starting with the January 2022 refresh of Care Compare, CMS will begin posting the average number of RN and total nursing (licensed and certified staff) hours worked per resident, per day, on weekends. But wait – it doesn’t stop with the addition to Care Compare. Beginning in July 2022, CMS will add a measure to the staffing rating domain – total nurse staffing on weekends. CMS notes in the QSO Memo that adding this measure will help to “encourage” facilities to add more staff on weekends. It also points out, however, that adding the weekend staffing information to Care Compare will provide clarity to consumers about how facility staffing rates vary daily.

Additionally, CMS also plans to make information regarding staff turnover available on Care Compare. The Agency had previously announced that it would be developing staff turnover measures to put on the site. Not surprisingly, CMS provides data in the QSO Memo that suggests that lower RN, total nursing staff and administrator turnover are associated with higher Five-Star Ratings. So, in addition to the weekend nurse staffing hours being added to the January 2022 Care Compare refresh, CMS will also be adding three new measures of staff turnover to the site. These include the percent of RN staff that left the facility over the last year, the percent of total nurse staff (licensed and certified) that left the facility over the last year, as well as the number of administrators that left the facility in the past year. These measures will be included in the staffing domain of the Nursing Home Five Star Quality Rating System in July 2022.

The QSO Memo also includes instructions on how providers should ensure that their employee identifiers are correctly linked to help ensure the turnover data is accurate.

Employee-Level Staffing Data

CMS also plans to make employee-level data available so stakeholders can conduct their own analyses of turnover data to help improve nursing home staffing levels.

  • Employee-level data will be posted in the PBJ section of data.cms.gov on January 26, 2022.
  • CMS will add the measures of turnover and weekend staffing to the facility-level files posted on the Provider Data Catalog,

For full details, view the January 7, 2022 CMS QSO Memo, “Nursing Home Staff Turnover and Weekend Staffing Levels” (Ref: QSO-22-08-NH). An updated Five Star Rating System Technical Guide is expected on January 14, 2022 and will include the specifications for the measures to be added.

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