After attending this session participants will be able to:
List the domains included in the Five-Star Quality Rating System,
Define recent changes to the Five-Star Quality Rating System, including how these changes have improved the quality of data being publicly reported to US consumers, and
Discuss potential changes in provider behavior and changes in provider performance related to safety, quality, and value since the implementation of the Five-Star Quality Rating System.
This work was supported through a contract with the Centers for Medicare & Medicaid Services (CMS), Center for Clinical Standards and Quality, Survey and Certification Group.
Complaint inspections are assigned to a time period based on the 12-month period in which the complaint survey occurred.
Complaint inspections that occurred between November 28, 2016 and November 27, 2017 receive a weighting factor of 60 percent, and those occurring between November 28, 2015 and November 27, 2016 have a weighting factor of 40 percent.
Facilities with only one standard health inspection prior to November 28, 2017 are considered not to have sufficient data to determine a health inspection rating and are reported as “Too New to Rate” for the health inspection domain.
The staffing data submitted on the CMS-671 captures only a two-week period prior to the facility’s annual recertification survey, whereas the PBJ data captures facility staffing for every day in a quarter.
The definitions of certain job categories have been revised for PBJ data submission compared to the instructions on the CMS-671 form, resulting in more precise reporting.
The PBJ data includes the census for each day in a quarter.
The PBJ program requires facilities to submit only those hours that staff are paid to work.
CMS calculates ratings for the QM domain using the
four most recent quarters for which data are
available.
Values for the three claims-based measures are
calculated in a similar manner, except that the data
used to calculate the measures use a full year of
data.
9
Abt Associates | pg 25
Missing Data and Imputation
MDS-based measures are reported if the measure can be calculated for at least 20 residents’ assessments.
The claims-based measures are reported if the measure can be calculated for at least 20 nursing home stays over the course of the year.
For facilities with missing data or an inadequate denominator size for one or more QMs, all available data from the facility are used. The remaining assessments (or stays) are imputed to get the facility to the minimum required sample size.
Step 2: Add one star to the Step 1 result if the staffing rating is four or five stars and greater than the health inspection rating; subtract one star if the staffing rating is one star. The overall rating cannot be more than five stars or less than one star.
Step 3: Add one star to the Step 2 result if the quality measure rating is five stars; subtract one star if the quality measure rating is one star. The overall rating cannot be more than five stars or less than one star.
Note: If the health inspection rating is one star, then the overall rating cannot be upgraded by more than one star based on the staffing and quality measure ratings. If the nursing home is a Special Focus Facility (SFF) that has not graduated, the maximum overall rating is three stars.
10
Abt Associates | pg 28
Change in Nursing Home Ratings
Events that could change the health inspection score include:
– A new health inspection (prior to 11/28/17).
– New complaint deficiencies (prior to 11/28/17).
– A second, third, or fourth revisit (for a survey before 11/28/17).
– Resolution of Informal Dispute Resolutions (IDR) or Independent IDR (IIDR) resulting in changes to the scope and/or severity of deficiencies (for surveys before 11/28/17).
New staffing data for the facility.
Changes in the QM rating for the facility (mid-month January, April, July, and October).
Note: Starting in February 2015, facilities required to have a 4- or 5-star staffing rating on either RN or total nurse staffing to have an overall staffing rating of 4-stars.
Abt Associates. (2014). Nursing Home Compare Five-Star Quality Rating System: Year five report. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/NHC-Year-Five-Report.pdf
Abt Associates. (2016). Nursing Home Compare Five-Star Quality Rating System: Year Seven Annual Report. Currently in draft.
Centers for Medicare & Medicaid Services. (2018). Design for Nursing Home Compare Five-Star Quality Rating System: Technical users’ guide. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/usersguide.pdf
Centers for Medicare & Medicaid Services. (2018). Staffing Data Submission PBJ . Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html
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