Five-Star Changes – Tell Me More!

Lyn Bentley, MSW

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.