Last week the Centers for Medicare & Medicaid Services updated 5-Star User’s guide to the Five-Star Quality Rating System website in the wak of overall changes that have been made to the 5-Star rating system. The latest version can be found here.
Providers quickly began to identify seeming discrepancies related to their ratings that didn’t seem to square with the April Five-Star revision material that CMS had made available in March. On further investigation it became clear that there are major differences to the user’s guide that resides on that website now. The changes appear to be primarily related to the cut point ranges for staffing and quality measures.
The tables below highlight the updates to the cut point tables for both staffing and Quality Measures from the April 2019 Five-Star User’s Guide that CMS released in March to the one currently posted.
As you can see, the only staffing cut points that were unaffected were the upper end of the Three-Star and lower end of the Four-Star total nurse staffing cut points. For the quality measure cut points, changes occurred primarily in the 2, 3 and 4 star cut point ranges.
March Update to 5-Star User’s Guide Staffing Cut Points
April 24 Update to 5-Star User’s Guide Staffing Cut Points
March Update to 5-Star User’s Guide Quality Measures Cut Points
April 24 Update to 5-Star User’s Guide Quality Measures Cut Points
Changes have also been noted related to the QM value ranges for points in Table 2A in the appendix for the following QMs:
- Rate of successful return to home and community from a SNF (short-stay),
- Percent of residents who self-report moderate to severe pain (long-stay),
- Percent of residents who self-report moderate to severe pain (short-stay),
- Percent of residents who newly received an antipsychotic medication (short-stay),
- Percent of short-stay residents who were re-hospitalized after a nursing home admission (short-stay),
- Percent of short-stay residents who have had an outpatient emergency department (ED) visit (short-stay),
- Number of hospitalizations per 1,000 resident days (long-stay) and
- Number of outpatient emergency department (ED) visits per 1,000 resident days (long-stay))
Providers would be well served to download the current version of the Five-Star User’s guide in order to have an accurate understanding of their 5-Star Rating that CMS posted to Nursing Home Compare on April 24. Having a precise understanding of their star rating will help SNFs to more clearly communicate with customers who may inquire about changes that may have occurred to their star rating with the April updates.
Joel VanEaton, BSN, RN, RAC-CT Master Teacher, is the Vice President of Compliance and Regulatory Affairs at Broad River Rehab.