The Five Star Preview Reports were available through the CMS QIES System on April 20th. Beginning with this update, each nursing home is able to review data from the new quality measures that will be added to the Nursing Home Compare website on April 27th
Providers should review this report to see how the nursing facility is performing on the new measures compared to peers.
New Claims Based & MDS Based Quality Measures (QMs)
On March 3, 2016, CMS announced changes to the Five Star Rating System. Six new QMs include four short stay and two long stay measures, three of which are claims-based (will report 12 months of data and be updated every six months) and three of which are MDS-based (updated quarterly):
- Percentage of short-stay residents who were re-hospitalized after a nursing home admission (claims-based).
- Percentage of short-stay residents who were successfully discharged to the community (claims-based).
- Percentage of short-stay residents who have had an outpatient emergency department visit (claims-based).
- Percentage of short-stay residents who made improvements in function (MDS-based).
- Percentage of long-stay residents whose ability to move independently worsened (MDS-based).
- Percentage of long-stay residents who received an antianxiety or hypnotic medication (MDS-based).
The new Nursing Home Compare Quality Measure Technical Specifications were released on April 14thand are available at: (https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/APPENDIX-New-Claims-based-measuresTechnical-Specifications-04-05-16.pdf)
These changes were implemented to increase the number of short stay-measures and introduce a new focus on self-performance in Mid-Loss ADLs.
Five Star Rating Impact
From April to July, the six QMs will be publicly reported on Nursing Home compare. Keep in mind, CMS will not be able to provide information about how the new QMs will impact each facility’s QM rating until closer to July. Beginning July 2016, CMS will phase in five of the measures into the Five Star Rating System, affecting providers’ QM ratings. Antianxiety/hypnotic medication measure will not be used in Five-Star due to concerns about its specificity and appropriate thresholds for star ratings, but all QMs are expected to be fully incorporated effective January 2017.
Providers Should Act immediately to Implement Proactive QAPI Strategies
- Effective QAPI systems that include data analysis and a focus on quality care in the QM target areas .
- Evaluate staff development needs in QM goal areas.
- Consistent assignment- have the right staff with the right residents at the right time.
- Review physician communication processes and consider how the use of non-physician providers (NPP) may benefit residents.
- Formalize programming for improved care transitions that includes not only discharge to the community, but also other non-skilled care settings.
- Operationalize systems to ensure MDS accuracy. The final risk adjustments are taken from multiple MDS items that have never been used before as part of the QM/Five star measurements. With increased MDS coding focus areas, strong systems and consistent accuracy are more important than ever.
- Most facilities have focused on accuracy of late-loss ADLs. Mid-loss ADLs are introduced with new QMs in areas of transfers, locomotion on the unit, and walk in corridor. Review internal ADL training and consider implementation of monitoring observation tools on the floor that include these new mid-loss areas.
- Consider the coming impact on reimbursement. In 2017, the Five-Star rating will directly affect participation in Comprehensive Care for Joint Replacement bundles with designated hospitals. In 2018, penalties for SNFs for hospital readmissions within 30 days of discharge are expected. New reimbursement models will include accountability for quality care and ACOs will depend on high quality care as well.
To Access the Five Star Preview Reports:
- Select CASPER Reporting link located on CMS QIES Systems for Providers page.
- Click on the folders button from the CASPER Reporting System.
- The Five Star Report is located in your ‘st LTC facid’ folder, where st is the 2-character postal code of the state in which your facility is located and facid is the state-assigned Facility ID of your facility.
The Five-Star Help line (800-839-9290) will be available from
April 25, 2016 through April 29, 2016
CMS will continue to make Provider preview reports available on a monthly basis in advance of public posting and will include the dates and hours of helpline availability. BetterCare@cms.hhs.gov is an alternative way to direct inquiries.
Stacy Baker, OTR/L, RAC-CT
Proactive Medical Review & Consulting, LLC