Industry trade groups slammed changes to Nursing Home Compare that went into effect on Wednesday, concerned that the Centers for Medicare & Medicaid Services is “moving the goalposts” for providers.
CMS’s switches to the ratings system caused about one-third of skilled nursing facilities’ ratings to drop drastically overnight without any corresponding dip in quality or staffing levels, the American Health Care Association estimated.
“Changing quality measures with little meaningful explanation for consumers about the differences between new and old measurements creates confusion,” Katie Smith Sloan, president and CEO of LeadingAge, said Wednesday. “Consumers researching nursing home care, as well as current residents and their families might erroneously conclude that a provider’s quality of care is compromised, when that’s not the case.”
“The abrupt change in star ratings for nursing centers may be confusing to consumers, residents and their families,” added David Gifford, M.D., senior VP of quality and regulatory affairs for the AHCA. “By moving the scoring ‘goalposts’ for two components of the Five-Star system, CMS will cause more than 30 percent of nursing centers nationwide to lose one or more stars overnight — even though nothing changed in staffing levels and in quality of care, which is still being practiced and delivered every day.”
CMS first hinted at the changes in March and warned providers Tuesday that their star ratings could plummet. Effective with the update to Nursing Home Compare this week, CMS is dropping the threshold that SNFs can go without a registered nurse onsite from seven days to just four. Those not in compliance will be downgraded from five stars to one. Two new measures tied to long-stay hospitalizations and emergency room transfers were also added to NHC this week.
Many SNF leaders were surprised to learn Wednesday that they have a one-star rating for registered nurses and overall staffing, said Amy Stewart, RN, vice president of curriculum development for the American Association of Post-Acute Care Nursing. She said it is “imperative” that facility leaders carefully review their submitted staffing data to ensure that it is complete and accurate.
Wednesday’s changes impact all three domains of the Five-Star program — survey, staffing and quality. The quality domain has undergone the most substantial changes, and for SNF providers who want to improve their overall star rating, that is likely the “best place to focus those efforts,” Tom Martin, director of post-cute care analytics at CarePort Health, told McKnight’s.