Medicare.gov announced 3 significant improvements to their Five Star Nursing Home Quality Rating System.
- Incorporated the 2 nursing home quality measures for antipsychotic use into the Quality Measure Rating.
- Increased the number of points necessary to earn a Quality Measure Star Rating of 2 or more stars.
- Changed the scoring method for the Staffing star rating. Nursing homes must earn a 4-star rating on either the RN or total Staffing rating to achieve an overall Staffing rating of 4-stars.
Many nursing homes will see a lower quality measure rating as a result of these changes, even though the underlying QM data may not have changed. Because of these changes, it is not appropriate to compare a facility’s QM ratings that appear in February with those that appeared in earlier months.
How Medicare calculates ratings
They create the Overall 5-Star rating for nursing homes based on three parts or domains: 1) Health Inspections; 2) Quality Measures (QMs); and 3) Staffing. Star ratings for each domain and the overall rating range from 1 star to 5 stars, with more stars indicating better quality.
They assign the Overall 5-Star rating in the following steps:
Step 1: Start with the Health Inspections Rating.
Step 2: Add 1 star if the Staffing rating is 4 or 5 stars and greater than the Health Inspections Rating. Subtract 1 star if the Staffing rating is 1 star.
Step 3: Add 1 star if the Quality Measures rating is 5 stars; subtract 1 star if the Quality Measures rating is 1 star.
Step 4: If the Health Inspections rating is 1 star, then the Overall rating cannot be upgraded by more than 1 star based on the Staffing and Quality Measure ratings.
Step 5: If a nursing home is a Special Focus Facility, the maximum Overall rating is 3 stars.
Description of Rating System:
- Health Inspections rating:
Medicare bases health inspection ratings on the three most recent comprehensive (annual) inspections, and inspections due to complaints in the last three years. They place more emphasis on recent inspections.
- Quality Measures (QM) rating:
Medicare combines the values on eleven QMs (a subset of the 18 QMs listed on Nursing Home Compare) to create the QM rating. QMs are derived from clinical data reported by the nursing home.
- Staffing rating:
Medicare bases the staffing rating on two measures: 1) Registered Nurse (RN) hours per resident day; and 2) total staffing hours per resident day. Total staffing includes: RNs; Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs); and Certified Nurse Aids (CNAs). Staffing data are submitted by the facility and are adjusted for the needs of the nursing home residents.
When families are selecting a Nursing Home for themselves or a loved one, it is important to review these ratings. Medicare.gov offers a Nursing Home Compare tool to assist with selecting the BEST Nursing Home that will meet their needs of location and quality of care.
The Home Compare Tool allows the user to select a specific Nursing Home, or to compare a variety of Nursing Homes in a zip code or city/state location.
The CMS released a PRESS RELEASE on 2/20/15 titled “CMS Strengthens Five Star Quality Rating System for Nursing Homes:
Beginning 2/20/15, nursing home star ratings will:
- Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.
- Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.
- Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.
The Medicare.gov Nursing Home Compare it a valuable tool for families to utilize during their search. The results include information regarding Overall Rating, Health Inspections, Staffing, Quality Measures and Distance. This information helps narrow down the options to consider, but should also include an onsite visit with Nursing Home.
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