Upcoming changes to Five-Star rating methodology will require long-term care providers to overhaul several key daily processes related to staffing and quality measure reporting, an informatics specialist warned this week.
Providers can adapt to the upcoming changes with careful planning and communication strategies, Jen Gross, a healthcare informatics specialist with Net Health said during a webinar.
The Centers for Medicare & Medicaid Services has changed the calculations it uses for its staffing measures. Beginning in July, the staffing acuity adjustment will be measured through case mix groups to determine how much staffing is needed to care for residents needs,
“That’s really huge because that has a big impact on the day-to-day processes in skilled facilities,” noted Gross.
The updates also replace four QMs entirely, changing how providers will code declines in activities in daily living, pressure ulcers, and other changes in mobility and function, Gross added.
While methodology is updated, Five-Star data for the affected staffing and QM measures are currently frozen. Staffing data will unfreeze in July, with QM updates finalizing in October 2024 and January 2025.
Preparing providers
Gross emphasized the importance of adapting to the staffing reporting changes — reminding attendees that not just poor performance but also significantly inaccurate reporting can result in a 1-star score and automatically deduct a star from a facility’s overall rating.
“The entire methodology for calculating staffing acuity needs to change to be adapted to PDPM,” she said, though she added that there is a bit of good news for providers.
“This change is actually a good thing when I was thinking about it,” Gross explained. “It might be easier if… facilities could continue to do Section G the way they always have been [but] if you think about it, that doesn’t do anybody any good because the acuity calculation becomes even more of a black box,” she said. “It’s better to rip off the Band-Aid and have a thorough understanding of how PDPM going forward is going to impact your case mix calculation for staffing.”
The new methodology will likely be a mixed blessing, Gross said. It will better capture residents’ acuity and comorbidities, which could lead to higher PDPM payments. But it could also mean higher expectations for staffing levels to handle those complexities.
Gross advised providers to plan ahead for the QM coding changes by being aware of the new measures being used, tracking data internally during the data freeze and anticipating any rating changes that might result during the unfreeze.
Staying ahead of the data restoration will be vital to providers, she explained.
“Remember that all of these changes to the MDS… come back to making sure we have really solid processes,” Gross said. “Collecting accurate data, making sure it’s up to date, and making sure submission of PBJ data is on time.”
Communication with partners, residents and their families is also vitally important, Gross said. She stressed the importance of working on messaging strategies around any updates and transparently keeping key groups informed.
