Caryn Adams

My April Five-Star rating is different from what I expected. Why?

In March, the Centers for Medicare & Medicaid Services posted changes to the Five-Star calculation methods that affected ratings beginning in April. 

The health inspection domain is unfrozen after allowing time for all facilities to be surveyed under the new process that rolled out November 2017. There are no changes to how this is calculated. It uses the results from the three most recent standard surveys and 36 months of complaint inspections.  

Points are assigned according to scope and severity of the citations received. Also taken into consideration is the number of repeat visits needed to obtain compliance. Each survey will be weighted as they were before.

There are big changes to the staffing domain, which will affect many providers. There will be a heavier emphasis on RN staffing. Facilities without an RN for seven days in a quarter formerly received a 1-star rating; that ceiling is now dropped to four days. Having four days without an RN in a quarter also triggers off-cycle surveys. 

The threshold levels also are changing to incentivize improved staffing.  Long-stay hospitalization and long-stay emergency room visits are being added to the Quality Measure Domain.  

There will be separate ratings for short- and long-stay measures to identify the care quality to specific populations in your facility, but the overall QM rating will be a combination of the two, as well as updating thresholds every six months. They also are changing scoring to give more weight to measures with greater potential for improvement. 

There also are new point thresholds. Rating thresholds have been adjusted in order to “raise the expectations for quality and incentivize continuous quality improvement.”