Changes to Five Star expected, providers fear lower ratings

Changes to Five Star expected, providers fear lower ratings
Changes to Five Star expected, providers fear lower ratings

The Centers for Medicare & Medicaid Services is expected to unveil major changes to Nursing Home Compare today that could cause facilities to lose rating stars, according to industry sources.

CMS is believed to be changing the overall cut-off points related to achieving certain star levels. If 11 new quality measures are aggregated under a new system, it's possible that as many as 15% of facilities could lose one or two stars virtually overnight, one source said. Another said that while CMS has conveyed that “some homes” may drop one or two stars, the agency has played it close to the vest as to how many facilities it believes would actually be downgraded.

CMS declined comment Wednesday in advance of its Skilled Nursing Open Door Forum, where the matter is expected to be discussed, starting at 2 p.m. ET today.

Unclear is whether any Five Star recalculations would be immediate or phased in, and what new scores would mean for skilled nursing facilities taking part in accountable care organizations or under managed care contracts.

Another possibility is that staffing levels could be recalculated. Current measurements for skilled nursing facilities related to staffing have long been criticized, notably by a recent New York Times story that fanned the flames. The Center for Public Integrity also accused one-fourth of nursing homes of self-reporting registered nurse staffing levels on Nursing Home Compare that appear to be double what Medicare cost reports said.

More antipsychotics focus

More certain is that CMS on Thursday will add measures for short-stay and long-stay antipsychotic use to the ratings matrix. Both major long-term care organizations have said they support such a move. CMS Chief Medical Officer Patrick Conway, M.D., confirmed in the fall that the Five Star system would start including antipsychotics measurements in 2015.

“We have definitely supported inclusion of antipsychotics of Five Star. We believe the public reporting and calculation of that into Five Star is a necessary next step,” said LeadingAge Senior Vice President of Advocacy Cheryl Phillips, M.D. However, “we are cautious about the broader Five Star methodology so that it doesn't inadvertently harm homes in given regions.”

The American Health Care Association/National Center for Assisted Living also has supported reduction of antipsychotics. But the organization has pushed back against rebasing the Five Star rating system. In December, AHCA/NCAL President and CEO Mark Parkinson said that with more than three-fourths of skilled nursing facilities receiving a four- or five-star rating, “we don't want them to rebase on the original curve.”

“Rebasing Five Star would be so confusing for families and residents,” AHCA spokesman Greg Crist added Wednesday. “If this happens, they're moving the goal posts. It sends the wrong message that quality in today's skilled nursing centers is on the decline when nearly every quality marker — both in and outside of Five Star — point to quality improving in our centers nationwide."

In addition to Nursing Home Compare issues, today's SNF Open Door Forum agenda also lists Admission/Entry and Reentry in the RAI User's Manual as a key topic.To see the agenda, with call-in information, click here.