In February 2015, CMS instituted three significant changes
to the Five-Star Quality Rating System. These changes resulted in most
nursing centers examining their 5-Star ratings more carefully as well as asking
questions about how Five-Star is calculated. Here are five questions and
answers about Five-Star to help you understand your ratings.
Q1. My annual survey was great – only two
deficiencies at an “E” level scope and severity. But my Health Inspection
domain is still only 2 stars. Why?
A1. The Health Inspection domain considers the
last three annual standard surveys as well as any complaint surveys for the
most recent 36 months prior to the Five-Star website update. Although the
previous surveys (both complaint and standard) are weighted at a lower rate,
they are still included in the calculation. Noncompliance points are also added if more than one revisit
is required to find a center in substantial compliance – and those points
are a percentage of the overall health inspection score. So
remember, a poor survey score stays with you for three years and needing
multiple revisits to clear tags also works against you! For more detailed
information about the Health Inspection domain calculation, see the Technical Users’ Guide.
Q2. My center has a number of residents with a
diagnosis of Schizophrenia. What will this do to my Quality Domain now
that CMS is considering quality measures associated with use of antipsychotics?
A2. In calculating use of antipsychotics, CMS
excludes use of these medications for individuals diagnosed with Schizophrenia,
Huntington’s disease, or Tourette’s syndrome.
Q3. After our annual survey, I realized there was
an error on our CMS Form 671. My staffing star is going to be terrible because
we forgot to include some staff. How can I get this corrected?
A3. Unfortunately, CMS does not allow corrections
to the information you submitted. It is essential that the
administrator of a center review this form for accuracy before it is given to
surveyors. Errors will remain in your staffing star until your next
survey. Some centers have the person who will be completing the form
practice regularly to help prevent errors and oversights.
Q4. Why does my center’s Five-Star information
say “Data Not Available” for the Staffing Star? I had my annual survey
and submitted the CMS Form 671. What’s up?
A4. There are two possibilities:
1). Much of the data used to calculate Five-Star is
input by each State Survey Agency. If for some reason there is a delay or
an error when they input the data, it can result in such a notation.
2). According to the Technical Users’ Guide, “A set
of exclusion criteria are used to identify facilities with unreliable CASPER
staffing data and neither staffing data nor a staffing rating are reported for
these facilities on the Nursing Home Compare website.” Put simply, if the
CMS Form 671 shows dramatic differences from previous submitted forms; the
exclusionary provision may kick in.
Q5. When RN’s from our corporate office are in my
building during the annual survey, may I count them on the CMS Form 671?
A5. These
individuals can be counted ONLY if they are actually providing care for
patients or if they are acting as the Director of Nursing or working in a nurse
administrative role (probably replacing an individual who is not working that
day/week). If the corporate RN is providing guidance or consultation to
the center, they may not be counted.
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