How the CMS Star Ratings System Changed in Response to COVID-19
Last updated September 1, 2020
What is the 5-Star Quality Rating System?
Each community is unique, with distinct resident needs, caregiving processes, and more. RCare takes the time to build customized, lasting solutions to meet the diverse needs of the communities they serve.
In 2008, the CMS star ratings system was created for the Skilled Nursing Industry by the Centers for Medicare & Medicaid Services (CMS). The system rates communities on a scale of one (lowest) to five (highest) stars in three areas, as well as assigning an overall star rating. The three areas of evaluation are: Health Inspections, Quality Measures, and Staffing.
The results are made available to consumers and families, on an easy-to-use website called Nursing Home Compare, to help them evaluate and compare skilled nursing communities. They can also be used by state agencies and regulators, payors, and business investors or lenders, to evaluate facilities.
Since its inception, the system has been changed and improved numerous times, most recently in March of 2019. These changes are planned and well communicated. But did you know that in 2020, as the COVID-19 pandemic began to rock the senior living industry and the country as a whole, it also led to rapid, temporary changes to the 5-Star Quality Rating System, changes that affect all three of the star ratings.
Changes to the 5-Star Quality Rating System Since COVID-19
Temporary Changes to the 5-Star Quality Rating System due to COVID-19, issued in July, 2020:
Because of the pandemic, and its dramatic impact on congregate living communities, CMS waived the requirement to submit data for the Staffing rating through the Payroll-Based Journal system. As a result, many facilities didn’t submit Q1 staffing data by the May, 2020 deadline. Therefore, instead of updating Staffing star ratings in July as scheduled, CMS kept existing ratings in place, those based on data from the last quarter in 2019.
An exception was made for facilities that had missed a previous deadline for Staffing data submission. Those communities had been downgraded one star as a late penalty. Rather than letting that lower rating persist, CMS opted to completely suppress the Staffing star rating for those communities, and instead is displaying “Rating Not Available” through September, 2020.
CMS waived the requirement to complete and submit timely resident assessment information, given the concern that the assessment results could be impacted by the residents’ reaction to changes imposed by the public health emergency. As a result, CMS continued to update Quality star ratings based on data through December 31, 2019, but then paused. It is not updating Quality star ratings for data collected after January 1, 2020.
More specifically, according to the Five-Star Quality Rating System Technical Users’ Guide, issued by CMS in July, 2020: “The MDS-based QMs will continue to cover 2019Q1 – 2019Q4. Four of the claims-based measures (long-stay and short-stay hospitalizations and ED visits) will be updated and will cover the time period January 1 – December 31, 2019. The short-stay QM, rate of successful return to home and community, will continue to cover October 1, 2016 – September 30, 2018.”
Health Inspection Rating
The Health Inspection star rating is based on inspections conducted up to and including March 3, 2020, but will not be updated to include data collected after that. Results of health inspections conducted on or after March 4, 2020, will be posted publicly through a link on the front page of the Nursing Home Compare website, but will not be used to calculate a nursing home’s Health Inspection star rating. CMS will communicate changes prior to when normal updates of Health Inspection ratings resume.
In March, 2020 CMS announced a new targeted inspection plan related to keeping patients safe from COVID-19, to commence on March 4. These targeted inspections focused on threats to patient safety and infection control, an attempt to identify situations of “immediate jeopardy.” This resulted in an increase in the number of facilities inspected, and the nature of the inspections, but it also led to a disruption in normal health inspection schedules. As a result, CMS paused updates to the Health Inspection star rating during the pandemic.
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With RCare’s reporting tools, you can measure important information about calls, such as call volume, frequent callers, and response times, to help you improve the experience of elders and their families, and staff work loads. For communities with multiple facilities, Enterprise RMetrix provides a dashboard that makes it easy to compare facilities on key metrics, by day, month or quarter. RCare gives administrators the kind of reporting that turns data into insight, and insight into action.
Every community is different, and RCare takes the time to understand the unique resident needs, caregiving process, and other issues, to build customized solutions that last.