Nursing facilities have made dramatic improvements in their Five-Star ratings in recent years, according to government data compiled and analyzed by Abt Associates and released at a May 16 Centers for Medicare & Medicaid Services (CMS) stakeholders meeting.

The data, which came from CMS, found that the proportion of facilities with overall five-star performance ratings increased by 34.7 percent, from 11.8 to 15.9 percent over the three years from January 2009, when Five-Star began, through December 2011.

During the same three years, the number of four-star centers rose 17 percent, from 23.4 percent of all facilities to 27.4 percent, the data showed. The number of one-star facilities, meanwhile, diminished substantially from 22.7 to 15.7 percent, a 44.5 percent decline.

“The long term and post-acute care profession has improved in nearly all meaningful quality measures in recent years, including staff and customer satisfaction,” said Gov. Mark Parkinson, president and chief executive officer of the American Health Care Association. While quality is a “continuous journey,” Parkinson said he was “excited about this positive trend.”

Each facility’s overall Five-Star rating is a composite based on separate scores in three domains: staffing, quality measures, and health inspections. The CMS data found that in the area of staffing, the proportion of five-star-rated facilities rose 23.6 percent, from 7.2 percent of all centers nationwide to 8.9 percent as of December 2011. The number of those with four-star staffing ratings jumped from 30 to 39 percent of all nursing facilities, a 30 percent shift. The number of one-star-rated facilities in this domain, meanwhile, dropped sharply, from 23 to 14 percent, a 64.2 percent decline.

Improvements in the quality measures domain were also striking, with the number of five-star ratings rising 60 percent, from 10 to 16 percent of all facilities. Centers with one star dropped from 20 percent of all facilities nationwide to 11 percent, a 45 percent decline.

According to Abt, the largest component of the overall rating is the health inspection (survey), which is designed to remain fixed in its distribution from month to month. As a result, the three-year change to the overall rating is due to the growing number of five-star-rated facilities in the quality measures domain; the increase in four- and five-star nursing centers in the staffing domain; and/or the decline in one-star facilities in each of these areas.