Providers could see an automatic shift in their federal star ratings thanks to several new changes to the system, including the controversial addition of a warning icon next to certain cited facilities and the removal of two pain quality measures.
The Centers for Medicaid & Medicaid Services announced Monday that it’s removing from the Nursing Home Compare website and the Five-Star Quality Rating System quality measures related to residents’ reported experiences with pain.
The measures being removed are: percentage of short-stay residents who report moderate to severe pain; and percentage of long-stay residents who report moderate to severe pain.
CMS also announced Monday that it will soon place a bright red “stop” hand icon next to facilities that have received recent abuse, neglect or exploitation citations.
Nursing homes with an alert icon will have their highest-possible health inspection rating capped at two stars and their overall possible rating capped at four stars, said Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of curriculum development for the American Association of Post-Acute Care Nursing.
Stewart added that providers could see a shift under the quality measures domain following the removal of the two measures. She strongly suggested that providers, especially those cited for abuse within the last 24 months, check their Five-Star Ratings once the changes go into effect on Oct. 23.
“Every facility across the United States is just one incident from getting this icon and then being capped at this two-star, four-star overall,” Stewart told McKnight’s on Wednesday.
She joined other providers in calling for CMS to address inconsistencies with surveys between states and to consider adding other determinants of quality instead of pursuing the “alert” icon, which some have pointed out actually conveys a much more foreboding “Do not proceed” message.
“Abuse is never OK,” Stewart said. “Abuse and neglect to the resident is never to be tolerated. We all agree on that, but the real issue is how surveyors determine whether abuse and neglect has occurred. We’re all one incident from potentially getting cited for abuse and then this icon being put up there.”
Quality measure thresholds will also be increasing under CMS’ latest efforts. The change could result in nursing homes seeing a decline in their ratings until improvements are made.
CMS will begin increasing quality measure thresholds by 50% of the average rate of improvement in QM score, and will do this every six months. The agency hopes the change will “drive continuous quality improvement by raising standards for all facilities to achieve certain ratings,” documents stated.
“As CMS changes the QM thresholds, some nursing homes will see a decline in their rating in these areas until they make further improvements. Also, because the QM ratings are also used as part of the overall rating, some nursing homes will see a decline in their overall five star rating,” CMS wrote.