Big Changes Incoming to Medicare’s Five Star Rating System

Posted On May 10, 2016 Medicare/Medicaid

The Centers for Medicare & Medicaid Services (CMS) will be implementing major changes to its well-known Nursing Home Compare Five-Star Quality Rating System. As of April 2016, CMS is now posting data for six new quality measures (QMs) on Nursing Home Compare.

The newly tracked measures are as follows:

1. Percentage of short-stay residents who were successfully discharged
2. Percentage of short-stay residents who have had an outpatient emergency department visit
3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission
4. Percentage of short-stay residents who made improvements in function
5. Percentage of long-stay residents whose ability to move independently worsened
6. Percentage of long-stay residents who received an antianxiety or hypnotic medication

Starting in July 2016, the first five of these measures will be used when calculating a nursing home’s Five-Star Quality Rating. Adding these measures to the rating system’s calculations will increase the number of short-stay measures, cover important domains that are not covered by other measures, and provide the public with a more accurate representation of a nursing home’s quality of service.

Why Are These Changes Important?

Up until now, the Five-Star rating has been based on what nursing homes have reported to the CMS. Because of this, some nursing homes would omit potentially harmful data related to the areas described above or alter their staffing numbers in order to boost their rating and call themselves a “Five-Star facility.”

This has had a significantly negative impact on the community, as many members of the public rely on the CMS rating system when placing a loved one in a nursing home. Once this update takes effect, nursing homes will be required to report more accurate data and will be less able to take advantage of the system, providing consumers with more accurate information to help them choose a nursing facility with confidence.

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