The federal Centers for Medicare & Medicaid Services (CMS) recently announced the addition of five new quality measures to its Five Star Quality Rating System for nursing facilities, effective August 10.
- Percentage of short-stay residents who were successfully discharged to the community (Medicare claims- and Minimum Data Set (MDS)-based)
- Percentage of short-stay residents who have had an outpatient emergency department visit (Medicare claims- and MDS-based)
- Percentage of short-stay residents who were re-hospitalized after a nursing home admission (Medicare claims- and MDS-based)
- Percentage of short-stay residents who made improvements in function (MDS-based)
- Percentage of long-stay residents whose ability to move independently worsened (MDS-based)
An updated Five Star Technical User’s Guide provides a detailed explanation of how CMS will calculate the facility rating for the Quality Measure (QM) domain in light of the new measures. Among other details, the Guide explains that the five new QMs will be phased in at two points: in July 2016 the new measures have 50 percent of the weight of the 11 measures currently being used (50 points possible for each of the new QMs instead of 100); in January 2017 the new measures will have the same weight as the 11 current measures (100 points possible for each individual QM).
The User’s Guide also highlights four additional methodological changes that affect the QM calculations that began in July (see the first page of the guide). CMS has not altered the scoring methodologies of the other domains.
The Five-Star Analysis Reports distributed quarterly by LeadingAge Indiana to all member and subscriber facilities will be updated to reflect these changes. However, there will be a delay in sending out the next round of reports. We anticipate all required programming will be completed so that reports can be sent to our facilities during early September.
The addition of the measures may have impacted member quality measure star ratings, as well as their overall rating. Until your facility-specific reports are available, you are encouraged to review the summary reports which provide national and statewide data comparisons.
As shown in the posted reports, nationally, 13.4% of providers saw a drop in their overall rating after the new measures went into effect on July 1, 2016. For the quality measure rating, 27.1% of providers nationally saw a decrease and 11.7% experienced an increase.