Caryn Adams

As recertification surveys resume, when will they start impacting the Five Star Quality rating?

The authorization to resume the survey and certification process has been given by the Centers for Medicare & Medicaid Services. States may be resuming, or making plans to resume surveys other than FICS or complaints.  

Health inspections and quality measures will be added into the Five Star Quality Rating System calculations beginning Jan. 27, 2021. In QSO 21-06-NH released on Dec. 4, CMS addresses the temporary waivers that impacted the information used to calculate the Five Star rating as well as the nursing home compare website. Of significant interest is that the focused infection control inspections will be used to calculate the rating and incorporated the same way complaint surveys are used. 

Quality measures will be updated using data based on the collection period ending June 30, 2020.  While waivers have been in place for the time frames to submit MDS data, they are still receiving enough data to calculate the QMs, “analyze for significant changes and take any actions needed to improve and protect resident health and safety.”

If you have not been monitoring your data, or acting on it, now is a good time to start. With the isolation of our residents from COVID-19 over the last nine months, we have all noticed the changes: increased depression, weight loss, and changes in cognitive or functional status.

These can and will be hot spots for surveyors. For those residents who have had significant changes, review the documentation and timeline as to what occurred and what the facility did to attempt to mitigate decline (was it avoidable?). 

Also, ensure that all data needed to be submitted for QRP and VBP have been captured.