CMS 5 Star Ratings of Nursing Homes

For the past several months, you may have been following along with our CMS (Centers for Medicaid and Medicare Services) Interpretive Guidelines series. In this installment, Devin Shelby, Administrator of Dickson Health and Rehabilitation, discusses the change in CMS nursing home rating procedures, most notably shifting the reviews to monthly from annually.

The CMS 5-Star Rating is the only standard measuring tool for nursing homes available to the public. It is comprised of 3 sections which include measurements of regulatory inspections, clinical quality and staffing. Facilities are rated from 1 to 5 Stars on each section, with a composite score for the overall rating. The public relies heavily on this tool when evaluating nursing homes. The tool has some significant shortcomings, most notably regarding staffing measurements:

1. Staffing measurements for the 5 Star Program are taken from a single two-week period prior to a facility’s annual inspection.
2. The resulting snapshot measurement is reported as the facility’s Staffing Star Rating for the entire next year.
3. Staffing in a nursing home can vary greatly over relatively short intervals, much less an entire year. This two-week snapshot is likely not indicative of the facility’s actual staffing throughout the year.
4. In some areas, there are up to 2 years between annual inspections, therefore staffing ratings could be up to two years old.
5. This can give the public a very inaccurate indication of actual staffing levels at any point in time, over a very long time.
6. Compounding this, if a facility receives a 1 Star rating in any of the 3 categories, such as staffing, the facility’s OVERALL Star Rating is automatically reduced by 1 Star for the ENTIRE year, or until the next “annual” inspection.

To summarize, this two week snapshot measurement often gives the public an inaccurate picture of a nursing facility’s actual staffing.

For more detail in reference to a significant change in the reporting intervals for facilities going forward, read this article. Starting in July 2016 facilities will report staffing on a monthly basis. This much shorter reporting interval will allow the public to have more accurate, almost real-time, staffing data for facilities they wish to evaluate. It will be a bit of a burden for facilities to report so often, but it beats the alternative of having potentially financially devastating and inaccurate staffing numbers posted on a public notice for an extended period of time.

Contact ALN Consulting with any questions regarding how this change may impact your case, or to better understand these guideline revisions.