by Shelly Maffia, Director of Regulatory Services, Proactive Medical Review
CMS released upcoming improvements to Nursing Home Compare and the Five Star Rating system that will go into effect in April 2019. Key changes that will take place in April include:
Health Inspection Rating:
- The freeze on the Health Inspection rating will end.
- Surveys occurring after Nov. 28, 2017 will now be included in the rating.
- Ratings will again be based on 3 cycles of inspections (3 most recent standard inspections and any complaint inspections occurring within the past 3 years).
- Cycles will return to pre-“freeze” weightings, with the most recent period (cycle 1) assigned a weighting factor of 1/2, the previous period (cycle 2) with a weighting factor of 1/3, and the third period (cycle 3) having a weighting factor of 1/6 of the health inspection score.
- Star ratings will not be displayed for Special Focus Facilities.
Quality Measure Rating:
- Separate Quality Measure ratings created for short-and long-stay measures.
- Each facility will continue to have an overall QM rating, which will be used to calculate the overall nursing home star rating.
- Overall QM rating will be equally based on the short-stay and long-stay quality ratings.
- Increased thresholds for ratings, based on the rate of improvement on QM scores since the last revision in February 2015.
- Every six months, QM thresholds will be increased by 50% of the average rate of improvement in QM scores to incentivize continuous quality improvement.
- Individual QMs will be weighted and scored differently.
High and medium weighting levels established. - Total number of points available for QMs with high weighting will be 150 points and medium weighing will be 100 points each.
- Points for QMs weighted “high” will be awarded by thresholds established at each decile, whereas points for QMs weighted “medium” will be awarded by thresholds established at each quintile.
- Individual QMs will be weighted and scored differently.
- Adding the long-stay hospitalization measure and a measure of long-stay emergency department transfers to the QM rating.
- Short-stay pressure ulcers and successful discharge to community measures are being replaced by the similar measures from the SNF Quality Reporting Program (QRP).
- Removing long-stay physical restraint measure from QM rating’s calculation, but will continue to report the measure on Nursing Home Compare.
Staffing Rating:
- Adjusted thresholds for staffing ratings to increase the weight registered nurse staffing has on the staffing rating.
- Four days (instead of seven days) without RN onsite will trigger automatic downgrade to one-star Staffing Rating.
About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.