Archive for: Five-star quality rating system
CMS announces future changes to Nursing Home Compare
In a memorandum released March 18, the Centers for Medicare & Medicaid Services (CMS) announced changes they plan to make to the Nursing Home Compare website on April 23 and July 21. Many of these changes were mandated by the Affordable Care Act.
On April 23, CMS will make the following three changes to the Nursing Home Compare website:
- Add information to allow consumers to more directly file complaints to state survey agencies about nursing homes. Such changes include adding links to state complaint websites, prominently posting state phone and fax numbers, and adding a standardized complaint form consumers can use in cases where they prefer to submit a complaint via fax.
- Add a more visible consumer rights section. This section will provide people with information about resident and consumer rights and courses of action people can take if they feel their rights are violated.
- Freeze the quality measure (QM) data and the Five-Star quality measure ratings currently on the website for a period of six months. Since the new MDS 3.0-derived quality measure data is not yet available, CMS will maintain the current QM scores and ratings until October 2011. CMS expects the MDS 3.0 QM data to be available in early 2012.
According to the memorandum, on July 21, “CMS will make an additional change to Nursing Home Compare to display information for each nursing about the number of substantiated complaints received and about the number of enforcement actions (specifically Civil Money Penalties and Denials of Payment for New Admissions) that have been levied.”
To read the memorandum in its entirety, visit our Resources page.
California SNFs must post 5-star ratings
As of January 1, California nursing homes certified by Medicare or Medicaid are required to post their rating determined by CMS’ Five-Star Quality Rating System. The legislation that mandated the public reporting of California Five-Star ratings, known as Assembly Bill 215, was signed into law by Governor Schwarzenegger on October 11, 2009.
The legislation requires Medicare or Medicaid certified nursing homes in the state of California to post their overall star rating information in at least the following locations:
- An area accessible and visible to the public
- An area used for employee breaks
- An area used by residents for communal functions and activities
The information, which should be posted on white or light-colored piece paper, must include the following, in the following order:
- The full name of the facility, in a clear and easy to read font of at least 28 point.
- The full address of the facility, in a clear and easy to read font of at least 20 point.
- The facility’s most recent overall rating determined by CMS’ Five-Star Quality Rating System. This information should be in the center of the page, in the form of the number reflecting the rating, and in a clear and easy to read font of at least two inches. A facility will have seven business days from the day it receives a new rating to post it.
- Below the star rating should be “The above number is out of 5 stars” in a clear and easy to read font of at least 28 point.
The legislation also requires nursing homes to provide consumers with a detailed explanation of their rating as well as how to access this information on the Nursing Home Compare Web site. Failure to comply with the provisions of this legislation will result in a class B violation, the fines from which will be deposited into the State Health Facilities Citation Penalties Account.
To read Assemble Bill 215, visit our Resources page.
Notes from the October 28 ODF
During the October 28 SNF Open Door Forum (ODF), CMS provided callers with updated information about the SNF PPS transition, MDS 3.0, survey and certification process, and technical issues with MDS data submission.
Some highlights from the ODF are as follows:
- CMS is still working diligently to develop a hybrid RUG-III system to comply with the partial RUG-IV delay included in the healthcare reform law. However, the Senate will be considering a repeal of the one-year partial delay of RUG-IV after the election. The House already passed the bill containing this provision in July. If passed, payment under the RUG-IV system will continue and no hybrid system will be needed.
- The National Quality Forum is currently voting on 17 quality measures. Voting will come to an end November 15. The current QM/QIs should be removed from the nursing home compare Web site and Five-Star scoring in April. The new QM/QIs should be posted on the nursing home compare Web site and used in Five-Star calculations sometime in the spring of 2012.
- Due to the technical issues with the MDS 3.0 Assessment Submission and Processing System (ASAP), some facilities may have difficulties complying with the transmission requirements under F287. Therefore, surveyors have been instructed to accept late submission time stamps for assessments submitted between October 1 and December 31. If a SNF did not comply with F287 and the noncompliance is not a result of problems with the ASAP system, surveyors can cite facilities at a lower level.
- CMS has received multiple comments that the requirement to complete the resident interviews with every indicated assessment can create a lot of work for SNF staff when two assessments must be completed in a short timeframe. For example, if a resident is discharged a few days after the ARD for a scheduled PPS assessment, the SNF staff would have to complete the resident interviews twice (once of each assessment) in a very short period of time. Although CMS will be looking into this issue in the future, facilities must continue to complete the interviews for each assessment where they are required.
- The majority of the questions during the Q&A portion of the call were about error codes received on final validation reports. Based on the answers to these questions, it seems like many of the errors may be occurring due to potential software problems. A list of all the error messages can be found in Chapter 5 of the MDS 3.0 Provider’s User Guide on the QTSO Web site. Providers should refer to this list to determine the cause of the error and necessary action they must take. If the error indicated by the message and description does not appear to be warranted, providers should contact their vendors to see if a possible software problem is causing the error, rather than a mistake by the facility.
The next SNF ODF will be held on Tuesday, December 9.
New study reveals five-star ratings do not match customer satisfactions
Holleran, a national research firm specializing in the not-for-profit senior living sector, released a study July 12 which shows that a facility’s five-star rating does not line up with how a resident or family member will rate their satisfaction with the facility. The study, which used data from 182 nursing homes, found that a higher percentage of respondents from one-star nursing homes would select the facility again compared to higher-rated nursing homes. For example, over 88% of respondents from one-star nursing homes would select the facility again, while less than 86% of respondents from four-star nursing homes would select their facility again.
“Therefore, we can say with reasonable certainty that the Five-Star rating process is flawed in terms of resident and family satisfaction, and the systemic issue appears to be in the lower Five-Star Rating categories,” Shawn Kepner, vice president of research at Holleran, said in a press release. “Furthermore, just simply relying on submitted data to calculate a rating number appears to be some of the reason for the systemic flaw. Additionally, the ‘forced distribution’ method, where nursing homes are rated based on where they fall in comparative percentile cutoff ranges, seems to be affecting the results of this study. If the Five-Star Ratings were calculated as absolute constructs instead of comparative percentile rankings, perhaps we would see a more logical relationship with resident satisfaction.”
Mr. Kepner continued, “The good news is that simply tweaking the process to include a satisfaction component and specifically focusing on improving the Five-Star rating process in the lower rating categories could go a long way in solidifying the process.”
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