The Five Star rating system, upgraded in 2009, combined with increases in online rating systems that the consumer relies on to make decisions, has definitely made a splash in long term care. The Five-Star Rating system has somewhat changed the way we choose communities for our loved ones. Consumer behavior still supports word of mouth references, geographic proximity and appearances certainly are very important when choosing a community; however, many hospital case managers and area agencies are looking for those 5 little stars. Increased need for Five-Stars has also impacted who our hospitals choose to partner with for health services. Let’s face it…even though this rating system doesn’t truly define you, it can make or break you.
The Five Star rating system consists of your health inspection survey, your staffing reported for the 2 weeks prior to the survey and your Quality Measures. For the purposes of this article I will not go into the specifics of the formula; however, you may go to http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html to get a full description and you may download the user’s manual as well. CMS of course recommend that to improve your star rating you decrease the frequencies and severity of state survey deficiencies, increase staffing if needed and concentrate on improving your Quality Measures.
This may all be easier said than done and many of the issues related to a bad state survey take time to clear off your record. However, your therapy department can help you in one large area that is updated quarterly and can make both a positive change on your Five Star rating and your state survey. Your Therapy department can make a difference in your quality measures. There are 7 long stay and 2 short stay measures that will impact your five start rating. The better you perform on your quality measures, the better your rating and ultimately, your survey.
Quality Measures as Listed in 5-Star Rating System:
| 7 Long Stay Measures | 2 Short Stay Measures |
| ADL Decline | New or worsened pressure ulcers |
| High-risk residents with pressure ulcers | Self-report moderate to severe pain |
| Indwelling Catheters | |
| Physically restrained | |
| UTI | |
| Self-Report moderate to severe pain | |
| Falls with major injury |
Ways Therapy Can Help
Therapy can impact several of these areas in 2 ways; we may be able to assess and provide treatments that will mitigate the decline or worsening condition or we may be able to solidify a case that the said decline is not preventable and all has been done that is possible to prevent the decline.
Start with looking at your quality measures (QI/QM) from your MDS reports. Therapy can use the patient specific report that shows who triggers for a particular care area. The key is if the person is triggering a quality measure, then there needs to be documentation that supports that this was not a preventable decline or there needs to be documentation of what was done to treat the condition or performance. Documentation is important even if you think you have done everything possible for this person. Long story short, if it is not documented, then you did not do everything you could do.
Examples of Therapy Interventions:
| Quality Measure | Potential Therapy Impact |
| ADL Decline | OT can treat ADL performance as well as cognitive issues related to the performance. If there is a mobility issue PT may become involved. = OT/PT |
| Pain | While not all pain is amenable to modalities such as heat, US, E-Stim and ice, etc… it could be worth at least an evaluation to determine and document such. Sometimes therapy can suggest positioning that will help some as well. = OT/PT |
| Falls | The root cause for falls can be difficult to find, the therapy team can work with the person for mobility, balance, room set-up, sequence of activities and behavior that may cause a high risk of falls as well as cognitive deficits.= OT/PT |
| Pressure Ulcers | Therapy can provide positioning, mobility assessment, as well as look at oral intake to see if the nutrition is there for healing to occur. = OT/PT/ST |
Therapy may be able to assist with the other quality measures as well. For example, for a urinary tract infection (UTI)—Is the person getting enough intake? Is there a hygiene problem when they toilet themselves? Etc. Working to use the skills of your therapy team can improve your quality measures which can improve your five star rating and assist with a successful survey outcome.
Focus on a proactive and solid quality assurance program wherein you look at your quality measures and use your team to find the root causes to problems in your facility. This will provide a great return on your investment of time and talent. Use your therapy team to assist you in rooting out those difficult causes and helping you to document your actions to care for your residents.
Christine Kroll, MS, OTR
Director of Operations
Healthcare Therapy Services, Inc.