Industry Insights

Changes to Five-Star Rating System Could Affect Long-Term Care Providers

February 2015
Author:  Amy Ray

Amy Ray

Senior Managing Consultant


Health Care

200 E. Main Street, Suite 700
Fort Wayne, IN 46802-1900

Fort Wayne

The Centers for Medicare & Medicaid Services (CMS) has made important changes to the Five-Star Quality Rating System that could significantly affect providers’ ratings. These changes are effective immediately and can be reviewed on the Nursing Home Compare website. A preview of the reports using the newly revised rating system was available for advanced provider review on February 13, 2015.

While no changes were made to the actual Quality Measure (QM) data collected, providers could see a significant change in their QM category rating—and subsequently to their overall star rating—due to the new calculation methodology. This also could lead providers to see a decline in their QM score even if there has been no actual decline in the quality of care provided.

Three changes have been made to the calculation methodology:  the addition of two new quality measures to the existing nine (out of 18 available), changes to the cutoff points for determination of each QM star level and changes to the staffing star category.

  • New Quality Measures – The new measures address short-stay and long-stay antipsychotic use.
    • The short-stay antipsychotic use QM will trigger if antipsychotic medication was not coded on the initial MDS in section N0410A but is coded on a subsequent assessment. The diagnoses of schizophrenia, Tourette’s syndrome or Huntington’s disease coded in Section I of the MDS will serve as exclusions for the triggering of the measure.
    • The long-stay antipsychotic use QM will trigger if any antipsychotic use is coded in section N0410A of the MDS unless schizophrenia, Tourette’s syndrome or Huntington’s disease is coded in Section I.
  • Cutoff Point Changes –The addition of the antipsychotic QMs used to calculate the QM star rating led to an increase in the number of points available. CMS reset the thresholds by increasing the number of points required to achieve a five-star rating. The actual point system used to assign points to each QM category also was revised.
    • While facility-specific scores are not published by CMS, providers can contact the Five-Star Help Line (800.839.9290) for a breakdown of their overall QM points as well as the points assigned to each QM category; the contact information for the help line is located on the Five-Star Report. This information can be helpful in determining the actual QM categories that affected QM rating changes as well as the total number of points required to achieve the next star level. The help line has expanded its availability in February and March from one week to two weeks.  
  • Staffing Star Rating Changes – Previously, a four-star staffing rating could be achieved if the data indicated both the RN staffing component and total staffing component were each assigned three stars. Under the new scoring rules, both the RN and total staffing component must be rated at the three-star level or higher, and one of the categories must be rated at the four-star level to achieve a four-star staffing rating.

With these changes, CMS is continuing its attempts to improve quality of care. The addition of the antipsychotic medication quality measures works toward CMS’ goal to reduce overall antipsychotic use in the long-term care population and stresses its expectation that providers review and make gradual dose reductions as appropriate. Increasing the total number of points required to achieve a five-star level quality measure rating encourages providers to make continuous progress toward quality improvement. Increased requirements to achieve the four-star staffing rating could improve the quality of care provided to the long-term care population.

If you have questions concerning the Five-Star Rating System or QMs, contact your BKD advisor.

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