What changes are coming to the 5-Star rating with the new refresh?
The 5-Star refresh was due out the end of April, as of this writing. When reviewing facilities’ ratings, we notice opportunities for improvement within each of the domains.
The Quality Measure (QM) Domain can improve the facility’s overall star rating by one star if the domain itself receives five stars.
To incentivize continuous quality improvement in skilled nursing facilities, the Centers for Medicare & Medicaid Services is increasing QM thresholds by 50% of the average rate of improvement in a QM score every six months. Facilities may see a decline in their QM star rating and, as a result, a decline in their overall star rating.
Reviewing the CASPER QM report should already be on the facility’s radar or in the QAPI plan. Incorporating the 5-Star rating into the facility’s QAPI program is equally beneficial.
Review each measure reported and how many points received. Identify those areas that should be targeted for improvement. Root cause why the score is low. Is it a documentation issue or an MDS coding issue? Does the staff need education on preventing ER transfers or rehospitalizations? Are there care areas that need more attention?
CMS provides a lot of information for consumers, surveyors and other auditors. It is important for facilities to use that same information to make improvements in care and documentation processes. The other domains should be reviewed and added to the QAPI program.
The Health Inspection Domain looks at a three-year history. Know what level of citations you can receive on your next survey in order to maintain or increase your rating helps to prepare your focus. The Staffing Domain is based on the PBJ submissions.