Guest Columns

Shining some light on the new Five Star system

The Five Star Technical Users' Manual for July 2012 is now posted on the CMS website and the updated Five Star results are on the Nursing Home Compare website. While consumers will continue to see a “star” rating for each Nursing Center, there were methodological changes which are worthy of discussion.

The Five Star overall score is comprised of three domains: Survey, Staffing and Quality Measures. In the July 2012 Technical Users Guide the survey domain is the same. This is not so for staffing and QMs.

There are three variables used in calculating staffing stars: actual staffing, expected staffing and national staffing averages. Expected Staffing is still calculated using data from the CMS Staff Time Measurement Studies but as of April 2012, MDS 3.0 data is used to calculate the RUG 53 groupers resulting in higher national averages for RN and Total Nurse Staffing hours, and the cut points for assigning “stars” are based on data through December 2011. (Last update was December 2008). Changes to two of the three variables mean a possible change in staffing “stars” even if your staffing numbers have not changed. This might be a good weekend to read Johnson's Who Moved My Cheese?

Analytically speaking, while your staffing numbers from your last 671/672 forms did not change, your RUG derived acuity leading to expected staffing, AND the cut points for star allocations did change, therefore scores will change. In a study of 13,413 facilities, PointRight found that these two changes resulted in 1485 SNFs (11.1%) experiencing a decrease in staffing stars and 1565 SNFs (11.7%) experiencing an increase in staffing stars. Of those SNFs experiencing a change, 622 SNFs (4.7%) had a decrease in overall Five-Star rating and 690 SNFs (5.1%) had an increase in overall Five-Star rating. Bottom line, your staffing rating might have changed even though your staff or residents did not.

For the QM component, CMS has chosen nine 3.0 measures to include in the composite score.  Seven from the Long Stay Population and two from the short stay population. These ‘familiar' measures come with new definitions of long- and short-stay populations, changes to the scoring process and a new point system. In the world of Five Star, the impact these changes had on the QM composite scores resulted in 33% of SNFs with an increased QM score, 33% of SNFs with a decreased QM score and 33% of SNFs with no change in QM score. Providers pay heed: comparing your old QMs to the new QMs is unproductive from a clinical operations perspective.

The take-home message for operators, providers, consumers and other stakeholders is to look a little deeper into the overall Five Star Scores this month, as the changes you see may be no more than someone ‘moving the cheese' as opposed to a shift in performance.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.