A stressed nurse
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Skilled nursing providers are worried they could see their star ratings drop following new changes to the quality measure rating threshold, according to a top expert. 

Care Compare’s April 2022 quarterly refresh, which is now available for providers, includes an adjustment to ratings thresholds in a push to raise the expectations for quality and incentivize continuous quality improvement. The update was first announced in a March 2019 memo but the pandemic delayed its implementation.  

The increases are based on the rate of improvement on quality scores since the last revision in February 2015. Quality measure thresholds will be increased by 50% of the average rate of score improvement. The ratings thresholds will now update every six months. 

“For example, if there is an average rate of improvement of 2%, the QM rating thresholds would be raised 1%,” the Centers for Medicare & Medicaid Services previously explained. The change will reduce the need to have larger adjustments to thresholds in the future, the agency added. 

“One concern providers may be facing with the increase in the QM rating thresholds is that they could experience decline in star rating even if their quality measure score remains the same,” said Jessie McGill, RN, curriculum development specialist for the American Association of Post-Acute Care Nursing.

“If a provider was just above the threshold for their current star rating, the threshold increase alone could result in the provider performance no longer achieving the same QM star rating,” she added. 

Providers also should be aware this could result in an overall star rating decrease in addition to a decline in the QM star rating domain, McGill told McKnight’s Long-Term Care News Wednesday. 

She added that the Five-Star Quality Rating System Technical Users’ Guide explains some situations how the overall star rating can be increased if the QM rating is high, and decreased if the metric is low. 

“So, if the provider had previously achieved a 5-star rating in the QM domain, and this decreased to a 4-star as a result of the threshold recalibration, this may result in a one-star reduction from the overall star rating,” McGill said. “Similarly, if the provider had a two-star rating in the QM domain, which decreased to a one-star, then the overall star rating could also decrease by one star.” 

She also stressed that the Five-Star quality rating system displays historic data and most of the quality measure data includes four full quarters of data with a delay in public reporting. 

“For this reason, providers need to ensure the accuracy of the MDS assessment and focus on continued improvement in quality measures,” McGill said.