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 Five-Star System Changes Yet To Be Published

Despite recent announcements, changes to the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System have yet to be published. CMS recently announced the changes would “go live” on the Nursing Home Compare website on July 27, but at press time the changes were not yet posted.
 
The changes include five new measures to be added to the quality measure (QM) component. Four out of the five focus on individuals admitted to a center for short-term rehabilitation following a hospital stay.
 
CMS originally introduced six new skilled nursing facility QMs in April of this year, then saying that five of them would be phased in beginning in July 2016. At the time of their inception, they will have 50 percent of the weight of the current measures until January 2017, when they will have 100 percent.
 
The five new measures being added to the scoring are:
 
1. Percentage of short-stay residents who were successfully discharged to the community (claims-based)
2. Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based)
3. Percentage of short-stay residents who were rehospitalized after a nursing center admission (claims-based)
4. Percentage of short-stay residents who made improvements in function (MDS-based)
5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
 
Despite the delay, leaders from the nation’s largest association of long term and post-acute care providers say that the changes are a step in the right direction, but more needs to be done to improve the system.
 
“We support CMS’ upcoming changes to improve the Five-Star Quality Rating System for consumers, which also align with our metric-based Quality Initiative to improve the lives of patients, residents, and families our skilled nursing care centers serve every day,” said David Gifford, MD, senior vice president of quality and regulatory affairs for the American Health Care Association (AHCA).
“While these changes will expand the information available to families and loved ones searching for the best place to received skilled nursing care, we need to include other factors to help them make their decision,” he said. “A recent CMS report shows that the profession is getting better on the number and severity of survey deficiencies, but the changes will not reflect this improvement.”
According to the CMS report, released in 2015, deficiency-free survey inspections increased from 8.8 percent in 2009 to 10.2 percent in 2014, and deficiencies related to substandard quality also decreased.
Through AHCA’s ambitious Quality Initiative, skilled nursing centers have attained improvements ranging from fewer rehospitalizations to decreased off-label use of antipsychotics.
Gifford also cautioned that comparisons between old and new ratings would be futile since the formula to calculate them will have changed: “The new star ratings that will reflect these changes cannot be compared to rankings prior because by adding new measures, CMS is no longer comparing nursing centers the same way as before—it’s like comparing apples to oranges,” he said.
Those in the long term and post-acute care profession echoed the positive step forward and need for continued development of the Five-Star system.
 
“It's encouraging for us to have the ability to offer comment and constructive advice in this important system,” said Glenn Van Ekeren, president of Nebraska-based Vetter Health Services, which owns and operates centers in Nebraska, Iowa, Kansas, Mississippi, and Wyoming. “So much hinges on getting Five-Star right—both for consumers and families as well as providers.
 
“We welcome this enhancement, but also know we should continue adapting and improving Five-Star so that it reflects true indicators of quality for years to come,” Van Ekeren said.
 
For more information, visit Nursing Home Compare.
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