New Changes in the CMS Nursing Home Compare Five-Star Quality Rating System

Five-Star Quality Rating System (QRS) has been developed by the Centers for Medicare & Medicaid Services (CMS) to assist consumers compare nursing homes more easily based on their performance on health inspection(s), staffing and quality measures (QM) domains. Over the years, CMS has updated and enhanced the five-star QRS methodology numerous times to improve the accuracy of the rating system. The nursing facilities and medical directors need to stay up-to-date with all the changes in the 5-star QRS.  

In April 2019, several changes were made to the Nursing Home Compare website and the Five-Star QRS. The following is a brief summary of the recent changes in all three domains. 

Health Inspection Domain: The rating methodology for the health inspection rating returned to what it was prior to February 2018. Specifically, results from the three (instead of two) most recent standard health inspections and 36 months of complaint inspections are used to calculate the health inspection score and determine the health inspection rating. 

Staffing Domain: The staffing rating thresholds were changed, with the staffing level required to receive a 5-star rating determined based on analyses of the relationship between staffing levels and measures of nursing home quality. Changes were made to provide more emphasis on RN staffing. (Tables 1 and 2)

Additionally, the overall and RN staffing ratings are set to one star for nursing homes that report four or more days in the quarter with no RN onsite or when nursing homes fail to submit any staffing data before the deadline. Finally, staffing ratings are no longer being suppressed for nursing homes that have five or more days with residents and no nurse staffing hours reported. 

Quality Measures Domain: The Nursing Home Compare website reports separate ratings for short-stay quality of resident care and long-stay quality of resident care in addition to an overall quality of resident care rating. Measures of long-stay hospitalizations and long-stay emergency department (ED) visits were added to the quality measure rating, and the long-stay physical restraints measure was dropped from the quality measure rating. The scoring rules for the quality measures changed to give more weight to measures with greater opportunity for improvement. Given the changes in measures and weights, there are also new point thresholds for the overall quality measure rating as well as the short-stay and long-stay ratings. 

Special Focus Facilities: Nursing Home Compare no longer displays an overall quality rating or ratings in any domain for nursing homes currently participating in the Special Focus Facility program.


CMS Five-Star Quality Rating System; Technical Users’ Guide - April 2019

Share this post:

Comments on "New Changes in the CMS Nursing Home Compare Five-Star Quality Rating System"

Comments 0-5 of 0

Please login to comment