Nursing homes to have first look at new quality-rating provisions today

Concerned providers will get their first look today at a newly rebased quality measurement scale under Nursing Home Compare 3.0. Individual facility details were expected to hit the usual online site by late morning today via the Quality Improvement and Evaluation System (QIES), officials announced Thursday.

Centers for Medicare & Medicaid Services officials, however, repeatedly declined to give details about how many facilities would be losing rating stars under the revised system. They did, however, confirm that they would be adding two metrics related to long-stay and short-stay antipsychotics.

Specifics of the revisions will be made public on Friday, Feb. 20, officials said during Thursday’s Skilled Nursing Facility Open Door Forum conference call.

The regulators emphasized the revelations about the changes were a “courtesy” to providers. That way operators could prepare for any questions about decreased ratings from staff, residents, or family members, officials said. Virtually all providers will be affected by the new system, they acknowledged.

Nursing Home Compare began in 1998 and CMS added the Five-Star Quality Rating System in December 2008. Initially using a bell-curve methodology, about 16% of facilities were given a top rating while around the same amount received just one star. The bell curve method was at least partially jettisoned in subsequent years, and most recently about 42% of facilities had been granted 5-star status. CMS officials declined Thursday to say how far back the cut lines will be, noting only that they had decided not to go back to 2008 levels because it would have been “too discouraging.”

The changes will be effective immediately, which has industry leaders worried.

“We are concerned the public won’t know what to make of these new rankings,” said American Health Care Association/National Center for Assisted Living President and CEO Mark Parkinson. “If centers across the country start losing star ratings overnight, it sends a signal to families and residents that quality is on the decline when in fact it has improved in a meaningful way.”

CMS strove to find a balance “between the sensitivity of quality measure dimensions, while not making too big of a change all at once,” said Thomas Hamilton, director of Survey and Certification Group. He also noted that “five star information should only be used as a starting point. There is no substitute for visiting the nursing home and consulting with community resources.”

The public release next week is expected to contain information that facilities can share with families and residents to answer questions and soothe concerns, Hamilton said.

Providers also will be facing adjusted staffing algorithms, CMS confirmed on Thursday’s Open Door Forum call. Nursing homes will have to earn four stars on the individual registered nurse level only, or the staffing categories (such as LPNs), if they aspire to receive four stars on the overall staffing level. A facility could not have fewer than three stars on any dimensions under the scenario above.

Additionally, some nursing homes in a pilot program are already submitting staffing data tracked back to payroll, with all facilities expected to be in this system by Dec. 31, 2016. CMS confirmed it is working with providers to make sure facilities’ payroll systems will be able to supply staffing data.

At least one provider asked Thursday if CMS would reconsider exceptions to antipsychotic use for the approximately 4% of residents diagnosed as bipolar. CMS currently gives exemptions to schizophrenic, Tourette’s and Huntington’s disease residents, but an official said bipolar disorder still has “definitional ambiguity.”

Another major improvement to Nursing Home Compare is scheduled for 2016, officials added.