Ask the payment expert: how to meet 'five-star' nursing home objectives
Ask the payment expert
The Centers for Medicare & Medicaid Services “Five-Star” program is complex and somewhat difficult to understand. According to the technical instructions from CMS, the staffing rating is based on two case-mix adjusted measures: total nursing hours and registered-nurse hours per resident day. The data used is the data that you provide to the surveyors during your annual survey.
The case-mix is based on the RUGs III case mix system, which originated from the time studies completed by CMS in 1995 and 1997. We anticipate that information will be updated when the STRIVE study is published sometime this year.
A formula is used to determine where you are based on the case mix of your residents and compared to national benchmarks. The national benchmark is 4.06 hours per day for all staffing and a minimum of .55 hours per resident day for RN staffing. CMS then determines your rating according to a scoring methodology. You can find the technical guidance at the Centers for Medicare & Medicaid Services Website.
Rate your own case-mix acuity level periodically to see how your staffing actually compares to a case-mix level of staffing. This also will give you great information to share with consumers.