Recently, I reviewed a webinar on the new Centers for Medicare & Medicaid Services’ Five-Star Rating System changes.
I have to be honest: I broke into a sweat as I was taken back to my high school physics classes, clutching the 400-page textbook and all. I can still smell the chalk, and the fear!
Everything a certain weight factor. (That means math, kids!) For example, the most recent period of health inspection will have a weight factor of ½; Cycle 2 (the previous period) will have a weight factor of ⅓, and the survey prior to that will have a weight factor of ⅙. Somehow, this equals one. I’m just waiting for someone to tell me I have to add a vector somewhere.
So, from what I could gather, CMS has updated the Total Staffing Hours Per Resident Day (HPRD) and RN Staffing HPRD cut points for the Overall Staffing and RN Staffing Ratings. (Yup, I’m lost, too.)
These updates utilize the 2018 fourth-quarter Payroll-Based Journaling data submissions by facilities across the country and have shifted based on PBJ distributions and the relationship between staffing and quality.
OK, now the Five-Star Staffing is calculated by the Total Staffing HPRD and RN Staffing HPRD. CMS has decided to emphasize RN staffing levels by rounding the Five-Star Staffing toward the RN Staffing rating. (OMG, I didn’t do so well in trig and analytic geometry!)
So, if you are a rural nursing home where it’s easier to shoot deer out of a speeding pick-up at 1 a.m. on a moonless night then recruit an RN from ANYWHERE, but you have more than enough competent LPNs, you are basically in the proverbial boat without a paddle.
But wait, there’s more. We now have two different sets of weights and updated thresholds. Previously, all measure rates were scored from 0 to 100 points. But now nine measures will be scored from 0 to 150 points and eight measures will be scored from 0 to 100 points. (Yeah, I’m scratching my head, too!)
Oh, and we are now adding a Long-Stay QM and a Short-Stay QM Rating alongside an Overall QM Rating. (YES, more math.) The points for the 10 long-stay quality measures will be added to provide a Long-Stay QM Rating. The seven short-stay quality measures will be added and multiplied by a factor of 1250/900 to provide a Short-Stay QM Rating. The 1250/900 factor is applied so short-stay and long-stay measures have equal weights when contributing to the Overall QM rating. The Overall QM score is the sum of the long-stay and short-stay QM scores. (Is anyone following this?)
Um, I actually want to be back in physics class, really. It was much easier! Because they are adding a Long-Stay QM and a Short-Stay QM Rating alongside an Overall QM Rating. And the simple explanation is this: “The points for the ten long-stay quality measures will be added to provide a Long-Stay QM Rating. The seven short-stay quality measures will be added and multiplied by a factor of 1250/900 to provide a Short-Stay QM Rating. The 1250/900 factor is applied so short-stay and long-stay measures have equal weights when contributing to the Overall QM rating. The Overall QM score is the sum of the long-stay and short-stay QM scores.”
One thing that didn’t change was how your health inspection star points are calculated, by the number of deficiencies averaged by the number of facilities in your state. So, for example, if your facility is in Georgia where there are only 354 facilities, just five deficiencies may cut you down to one star in the survey area. Now compare that to California, where there are 1,187 facilities, allowing more deficiencies before you get dropped to one star.
So, bottom line: A one-star can be better than a two-star, or a three-star might now be as good as a two-star but I can’t figure it out. This can leave not only the general consumer confused, but even us professionals. Right?
I mean, with hotel ratings where you pretty much know what you are getting at a one-star. At a one-star hotel you know there’ll be a bed, though a bit lumpy or saggy. There will be a shower, though you may have to soap yourself up (on an itty-bitty soap sliver) to turn around in it. In addition, it will be off of (or just on) a major highway where you will be “rocked” to sleep by semis going by all night long. You will NOT want to get in the pool if there is one, and please don’t get ice out of the ice machine. No one-star hotels for this germaphobe, please!
But at least I know what I am getting with a one-star wedding. The wedding will be held at a hall — not just the ceremony, the actual wedding. The bride will most likely be pregnant and wearing a very tight and skimpy gown. Her mom or her aunt just recently gave her a pink-and-blue themed bridal shower (isn’t that adorable!).
Instead of a “just married” sign on the back of the vehicle, there is something a bit more suggestive on the back of the groom’s truck, just under his gun rack, with which he and his groom’s men have taken endless selfies. It’s either beer by the keg or BYO ’shine.
Someone is going to get in a fight. Not an argument but a smackdown, WWE worthy, make-a-trip-to-the-ER kind of fight. And it most likely will involve a bridesmaid hanging off of someone’s back.
But the food is all potluck and pretty darn amazing. Cousin Donnie’s got the music playing and the groom is offering his new bride at a dollar a dance — and she’s banking major cash!
The thing is, I totally understand it. I’ve been to a bunch of these and know what I’m getting at this one-star … no math involved!
Just keeping it real,
Nurse Jackie
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.
