CMS Releases Changes to Five Star Quality Rating System

On February 12, CMS announced changes to the Five-Star Quality Rating System that will impact how CMS assigns stars for both the Staffing and Quality Measure components, which may impact a skilled nursing center's Overall rating. CMS also will add two new measures to the Quality Measure component: the short-stay antipsychotic measure and the long-stay antipsychotic measure that CMS has been using on Nursing Home Compare for the past several years.

CMS will release to the  public these changes on February 20th and will be holding a press briefing on the changes.  Based American Health Care Association’s (AHCA) estimates, 165 out of 516 facilities in Indiana will see a decrease of either 1 or 2 stars, 351 facilities will see no change, and 1 facility will pick up one star.  These are estimates and may differ from what CMS posts.  See below under Resources to access this information.

Following is a summary of the changes to the Five-Star components:

Overall Five-Star rating
No changes to methodology but changes to Staffing and Quality Measure (QM) components will impact your overall rating

Survey component
No changes

Staffing component
Changed how 3- and 4-Star ratings are determined on Staffing component.

Quality Measure component
Added two new Quality Measures to the current nine QMs:
 - Short-Stay use of antipsychotics
 - Long-Stay use of antipsychotics

Rescaled the Cut Points
For each star level on the Quality Measure component, the cut points were moved. CMS did not provide the new cut points on the call but will release this information in the new technical user's manual.  This will result in many members losing one or two stars on the Quality Measure component. Since the QM component contributes to the Overall rating, a sizable number of centers may also lose a star on their Overall rating.

• Resources

AHCA has been working to put together a number of resources on these changes for its members and state associations.  AHCA has a dedicated website for this information at www.ahcancal.org/FiveStar.  IHCA has taken this information and placed it in our member’s only website as well.  Click here to access that information.  For either the AHCA or IHCA websites, you will need a member ID and login.  The resources are:

• A PowerPoint explaining the Five Star Changes
• Instructions on How to access Five Star Preview Reports
• Sample Letter to Payers Regarding Five Star Changes
• Templates for Communications to Families and Media, as well as general talking points
• Overview of Five Star revisions for the Nation and Indiana
• An Excel spreadsheet of all Indiana NFs with estimated impacts (these impacts are based upon AHCA’s replication of the CMS user guide – actual results may differ once CMS releases the data on Feb. 20th)

IHCA and AHCA will continue to monitor and analyze the changes to the Five Star system and keep you updated.