Stay Connected with Industry News, Emerging Risks

Caitlin Morgan through our blog and newsletter is committed to keeping our agency partners and insureds abreast of trends, emerging trends and developments as they relate to the segments we serve. We invite you to connect and engage with us.

CMS Changes to Five Star Nursing Home Quality Rating System in Full Effect January 2017

Chris Murray
Posted on: December 13, 2016 by Chris Murray

In July 2016, the Centers for Medicare & Medicaid Services (CMS) made several changes to the quality measure domain of its Five Star Nursing Home Quality Rating System. Three of these measures are based on Medicare claims data submitted by hospitals. Until the addition of these quality measures, the CMS quality measures were based solely on data self-reported by nursing homes.

The new quality measures are:
  • Percentage of short-stay residents who were successfully discharged to the community (claims-based)
  • Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based)
  • Percentage of short-stay residents who were re-hospitalized after a nursing home admission (claims-based)
  • Percentage of short-stay residents who made improvements in function (MDS-based)
  • Percentage of long-stay residents whose ability to move independently worsened (MDS-based)

These measures, according to the CMS, greatly expand the number of short-stay measures used on the Nursing Home Compare website and add important domains not covered by other measures. The five new quality measures began being phased in July 2016 and have had a 50% the weight of the current measures. In January 2017, they will have the same weight as the current measures.

The CMS launched Nursing Home Compare in 1998, adding the Five Star Nursing Home Quality Rating System in 2008, to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare website features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above-average quality and nursing homes with 1 star are considered to have quality much below average.  There is one overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

  • Health Inspections – The health inspection rating contains information from the last three years of onsite inspections, including both standard surveys and any complaint surveys.  Trained, objective inspectors go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicaid and Medicare’s minimum quality requirements. The most recent survey findings are weighted more than the prior two years.
  • Staffing – The staffing rating has information about the number of hours of care provided on average to each resident each day by the nursing staff. This rating considers differences in the levels of residents’ care need in each nursing home.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.
  • Quality Measures (QMs) – The quality measure rating has information on 11 different physical and clinical measures for nursing home residents. The rating now includes information about nursing homes’ use of antipsychotic medications in both long-stay and short-stay residents. This information is collected by the nursing home for all residents. The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.

The additional quality measures, according to the CMS, represent a sustained effort by the agency to emphasize the quality of patient care. Nursing home providers should be aware that discharges, emergency department visits, and re-hospitalizations are now factored into a facility’s rating, and the CMS will evaluate claims data for this information.

About Caitlin Morgan

Caitlin Morgan specializes in offering comprehensive nursing home insurance programs, including General Liability & Professional Liability, Excess Liability, Property, Commercial Auto, Equipment Breakdown, Crime, Workers’ Compensation, D&O and other coverages. In addition, along with RTW, an industry leader in providing integrated Workers’ Compensation, disability and productivity solutions, we are endorsed by the Indiana Health Care Association (IHCA), HOPE, and Leading Age Indiana associations to offer a cost-effective Workers’ Compensation solution for their current members. For more information about our nursing home insurance solutions, contact us at 877.226.1027.

Please follow and like us:

Posted in: blog Nursing Home