MDS Alert

Published on Thu Apr 04, 2019 PDF

Take note of these major takeaways in how your facility will be evaluated.

The Centers for Medicare and Medicaid Services (CMS) are about to implement significant changes to the Five-Star Quality Rating System and Nursing Home Compare via adjustments to quality measurement (QM) evaluations.

2018 Surveys Now Incorporated

“In April 2019, we will end the freeze and begin including inspections of facilities conducted on or after November 28, 2017 into a facility’s overall star rating calculation. Ratings will again be based on three cycles of inspections (the three most recent standard inspections and any complaint inspections occurring within the past three years),” says Karen Tritz, acting director of the Quality and Safety Oversight Group at CMS in Baltimore, in a March 2019 memorandum.

Remember: CMS assigns various weights to inspections to determine each facility’s rating. “The most recent period (cycle 1) [is] assigned a weighting factor of 1/2, the previous period (cycle 2) with a weighting factor of 1/3, and the third period (cycle 3) [has] a weighting factor of 1/6 of the health inspection score,” Tritz says.

SFF Ratings Hidden

Additionally — and separately — CMS will suppress the star ratings for the approximately 90 special focus facilities (SFFs), which have been identified as having “serious quality issues” in the past. CMS says that it believes that noting that the facilities are SFFs via a special icon, while hiding the actual star ratings, will reduce confusion amongst consumers.

Resource: For more information on CMS’s updated SFF initiative, read here: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/SFFList.pdf.

CMS Separates Short-Stay and Long-Stay Ratings

CMS is separating the quality measures for short stays and long stays in recognition that the goals for residents in nursing facilities may differ depending on their situations. CMS acknowledges that short-stay residents are actively trying to improve their health status so they can resume living elsewhere, while long-stay residents are receiving care that can better be described as maintaining their status and function while they remain at the facility. CMS is enacting the change for the benefit of potential consumers, so they’ll better understand how each facility handles various situations and goals, Tritz says in the memorandum.

“Each facility will continue to have an overall QM rating, which will be used to calculate the overall nursing home star rating. The overall QM rating will be equally based on the short-stay and long-stay quality ratings,” Tritz says.

Resource: To see the entire memorandum, read here: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-08-NH.pdf.

Look for These QM Updates

CMS is adjusting the QM thresholds, based on the rate of improvement of QM scores, in order to nudge facilities toward progress and incentivize quality improvement, Tritz says. The adjustments are coming for the first time since February 2015.

“As CMS changes the thresholds and methodology for performance on both the Quality Measures and Staffing domains, many nursing homes will see a decline in their rating in these areas until they make further improvements. Because the QM and Staffing ratings are also used as part of the Overall rating, some nursing homes will experience a decline in their Overall Five Star Rating,” she says.

Some facilities, however, may experience a boost in their ratings.

CMS notes that potential consumers should not use the QM or Nursing Compare rating as their only benchmarks of quality in a nursing facility, and individuals should do more intensive research on any prospective facility. Facilities should make a point of preparing their administrators, other staff, resident council, and even current residents for questions from potential residents about what they should expect if they choose a particular facility.

Note Staffing Threshold Adjustments

CMS is changing the threshold for staffing ratings, as well as changing the weight that registered nurse staffing incurs within the rating, in further efforts to incentivize facilities to improve their staffing levels.

Additionally, CMS is increasing the penalties for not having a registered nurse on-site. In the past, facilities would automatically receive a 1-star rating if they reported seven days in a quarter where a registered nurse was not on-site for eight hours a day. Beginning this month, April 2019, the penalty threshold is being reduced so that facilities will receive a 1-star rating if they report four days without a registered nurse on-site.