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 CMS’ Five-Star Adjustment Causes Nearly One In Three Skilled Nursing Centers To Lose A Star

The Centers for Medicare & Medicaid Services (CMS) on Friday made formal a rebasing of its Five-Star Quality Rating System for nursing homes, causing nearly one out of every three of the nation’s post-acute care providers to be downgraded by administrative order.

“Any time that nearly a third of an entire sector is impacted by a change of this magnitude, there will be confusion,” said AHCA/NCAL President and Chief Executive Officer Mark Parkinson. “We’re not helping patients and their families get the information they can trust when the star ratings don’t match the quality care being delivered.”

The CMS Nursing Home Compare website, (, which houses the Five-Star Quality Rating System, is one of the agency’s busiest, with 1.4 million customer views each year and 85 percent of customers finding their nursing home information from it, according to the agency. CMS added the system on December 2008. Star ratings allow users to see important differences in quality among nursing homes when making care decisions, CMS says.

The agency rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and staffing levels. These three categories are used in calculating the overall star rating, but consumers can see and focus on any of the three individual categories, CMS says. The agency also recommends that consumers consider community reputation and visit facilities personally. Further system adjustments, involving hospital readmission rates from nursing homes, is scheduled for 2016.

Starting Friday, nursing home star ratings include: two quality measures—for short-stay and long-stay patients—related to antipsychotic use; improved calculations for staffing levels; results from onsite quality assessment surveys; and tougher standards for achieving a high quality measure rating.

CMS acknowledged in its preliminary briefings last week that it was “inappropriate” to compare the previous Five-Star rankings with the new announced rankings.

“The level of performance we expect that was there in 2008 we don’t think suffices for 2015. We expect improvement over time,” said Patrick Conway, MD, CMS deputy administrator for innovation & quality and CMS chief medical officer, in Friday’s press conference. “Just as the Model A was excellent at its time, it would not measure up to other models today.”

Jackie Oberst is Provider’s managing editor. Email her at Follow the magazine on Twitter @ProviderMag.
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