Last week Medicare’s Nursing Home Compare website ( launched a five-star rating system for all nursing homes nationwide. Accordig to CMS, individual nursing homes will receive one to five stars in three categories — quality measures, nurse staffing and health inspections — as well as an overall rating. It will be the first time the Centers for Medicare & Medicaid Services (CMS) has used such a rating system. According to CMS the five-star rating system provides a new, simple, easy-to-understand approach to making what might be the hardest decision ever — putting a loved one in a nursing home.

I’ve taken a look at some information about this and want to share it with you. I will review the site more and we can discuss it more later. This has been such a busy month, and sometimes I get home so exhausted from surveys – I don’t get to writing like I should!

So the information, which has been sent to me by what I believe is a firm helping CMS to get the word out, is in the form of an adobe powerpoint slide presentation. The presentation explains that all nursing homes that are Medicare & Medicaid Certified (16,000 in the nation – and counting!) will receive a 1 to 5 star rating (I imagine it is something similar to rating systems used in many other avenues of life.)  The five star rating summarizes specific information for each nursing home. These areas are: 1. An Overall rating, 2. Health Inspections, 3. Quality Measures, and 4. Staffing.

For the health inspections, the star rating takes into account the 3 most recent annual inspections, with the most recent having the most weight, and all complaint investigations for the last three years. The rating considers the number and the Severity and Scope of the deficiencies, with the more serious ones lowering the star rating. If you remember, in July, we discussed Severity & Scope.

CMS selected 10 Quality Measures (we have not yet discussed this, but I will address that in a future post), which are basically what they sound like, measures of the quality of care in a facility. CMS selected the 10 measures with the highest reliability ans uses the three most recent quarters of data to help determine the star rating. I do want to point out that the quality measure data is dependent on the nursing home providing accurate data. The 10 that CMS selected to assist in determining the star rating for nursing homes are: ADL (Activities of Daily Living) change, Mobility change, High Risk Pressure Ulcers, Long Term Catheters, Physical Restraints, Urinary Tract Infections, Pain (for both Long Stay and Short stay), Delirium, and Short Stay Pressure Ulcers.

For staffing data, the star rating takes into account the number of hours of care on average provided to each resdient each day, the nursing staff (meaning RNs, LVN/LPNs and CNAs). CMS has adjusted these to account for differences in the level of care resident of different nursing homes may need.

5 Stars = Much above average, 4 Stars = Above Average, 3 Stars = Average, 2 Stars = Below Average, and 1 star = Much Below Average.

For the Overall rating it appears the calculation of the number of stars is in steps and Step 1 starts with the health inspection rating. Step 2 takes into account the staffing, and they add 1 star for a 4 or 5 star staffing and subtract a star for 1 star rating. The 3rd step adds 1 star for 5 Star Quality Measures and subtracts a star for 1 star Quality Measures.

So it appears each item has its own stars and then an over all star system is also determined.

I’ll take some more time to help you understand the system, and if you have any questions you’d like me to ask, feel free. The group who sent me the information stated I could talk to a CMS spokesperson if there were questions. Although this information is mostly for consumers, I can see an Nursing Home and Hospital Surveyor taking a look at this information during their offsite preparation for a survey.


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