New Measures to Impact Five-Star Ratings on July 27

David Gifford, MD, MPH 

AHCA Senior Vice President, Quality & Regulatory Affairs

The Centers for Medicare & Medicaid Services (CMS) reported yesterday that starting on July 27 at 10 AM ET the Quality Measure (QM) component of the Five-Star Rating System will reflect five of the six new QMs that are currently featured on Nursing Home Compare (NHC).  In March the agency announced this and other changes. For a summary of that presentation and a list of the new measures, click here. 

CMS also announced that it has posted an updated Technical User's Guide on its website here. On the second page of the guide, there is a short list of the overall changes skilled nursing care centers can expect.  Below are the key changes outlined in the guide: 

• The five new QMs will be phased in between July 2016 and January 2017. 
• In July 2016, they will have 50 percent of the weight of the current measures. 
• In January 2017, they will have the same weight as the current measures. 
• The methodological changes that will be introduced in July include: 

          -  Using four quarters of data rather than three for determining QM ratings.
          -  Reducing the minimum denominator for all measures (short-stay, long-stay, and                    claims-based) to 20 summed across four quarters.
          -  Revising the imputation methodology for QMs with low denominators meeting                        specific criteria. A facility's own available data will be used and the state average                  will be used to reach the minimum denominator.
          -  Using national cut points for assigning points for the ADL QM rather than state-                      specific thresholds. 

The Association recommends member centers review the guide for more details.

In addition, the agency is making changes to the CASPER provider preview report. The revised report will incorporate the new measures, display updated star ratings, and include a new column that shows the points assigned to each QM for a better understanding of the quality rating.  All skilled nursing care centers will have access to their preview reports through the QIES System by the end of next week. The MDS coordinator at your center will know how to access the report. 

On Thursday, July 28 at 3 PM ET, AHCA will host a members-only webinar to walk through these changes and answer questions. Please register here. 

In the meantime, members should continue to take steps to prepare for these upcoming changes. Resources, including the updated Technical User's Guide and instructions on how to access the QIES system, are available on the members-only Five-Star ahcancalED website here. The AHCA Quality Initiative website here, along with blog posts here and here, provide additional tips and resources.