Providers could see an automatic shift in their federal star ratings thanks to several new changes to the system, including the controversial addition of a warning icon next to certain cited facilities and the removal of two pain quality measures.

The Centers for Medicaid & Medicaid Services announced Oct. 7 that it was removing from the Nursing Home Compare website and the Five-Star Quality Rating System quality measures related to residents’ reported experiences with pain. 

The measures removed are: percentage of short-stay residents who report moderate to severe pain; and percentage of long-stay residents who report moderate to severe pain. 

Meanwhile, nursing homes with an alert icon will have their highest-possible health inspection rating capped at two stars and their overall possible rating capped at four stars, noted Amy Stewart, vice president of curriculum development for the American Association of Post-Acute Care Nursing.

Stewart called on CMS to address inconsistencies with surveys between states and to consider adding other determinants of quality instead of pursuing the “alert” icon.