MDS Alert

Also, you now have 2 new quality measures to report on.

The Centers for Medicare & Medicaid Services (CMS) has initiated a major overhaul of its quality rating system for the Nursing Home Compare system, and a “rescaling” of your Five-Star Quality Rating System scoring will have a negative effect on many facilities’ scores. Here’s what to expect.

On Feb. 20, just after press time of this MDS Alert issue, CMS released a revised quality rating system, dubbed “Nursing Home Compare 3.0.” In a Feb. 12 Skilled Nursing Facility (SNF)/Long Term Care (LTC) Open Door Forum (ODF), CMS officials announced a substantial retooling of the Five-Star Quality Rating System and the quality measures reported on the Nursing Home Compare website, which included two significant changes and one more minor change.

CMS allowed a private preview of the new system on Feb. 13 for participating SNFs and nursing homes.

Report on Short- and Long-Stay Antipsychotic Measures

CMS has added two new antipsychotic medication measures to the Five-Star calculations, one for short stay and one for long stay. Although you’ve been reporting antipsychotic quality measures, until now CMS has not included them in the Five-Star system scoring, noted Thomas Hamilton, director of the Survey and Certification Group in CMS’s Center for Clinical Standards and Quality, in the Feb. 12 ODF.

The addition of these two new measures brings the total of quality measures you report for the Five-Star system to 11 — eight long-stay measures and three short-stay measures.

Listeners on the ODF conference call expressed concern over the short-stay antipsychotic medication measure, particularly the concern that a short-stay resident isn’t in the facility long enough to gradually reduce antipsychotic use. But CMS officials reassured listeners that the short-stay measure would specifically focus on increases in or new use of antipsychotic medications.

Beware: Rescaling May Cause Your Score to Plummet

CMS’s second major change is a total rescaling of the rating scoring system dimensions. The rescaling increases the standards to achieve high ratings and effectively resets the quality measure scale, Hamilton said. The rescaling affects the 11 Five-Star quality measures, but does not impact the other quality measures you report for Nursing Home Compare.

Not every facility will lose a star or experience a decrease in quality rating due to the rescaling, but many will experience negative effects in this way, CMS officials stated. But when listeners pressed officials to specify a percentage or number of facilities that would have lower quality scores or star ratings, officials would not offer up any specific counts.

For many facilities, the rescaling will cause scores to drop without any actual reduction in quality. Hamilton pointed out that performance improvements that might have been good back in 2008 would be mediocre improvements under the new scoring system.

Likewise, CMS officials remained tight-lipped on other specifics surrounding the Nursing Home Compare and Five-Star system overhaul, telling ODF participants that facilities would receive more detailed information on the various changes after the Feb. 20 release.

Pay Attention to Staffing Measure Changes

A third change involves minor adjustments to the staffing quality measure dimension, which will affect fewer nursing homes than the rescaling. Stemming from mandates in the Affordable Care Act (ACA) and the IMPACT Act, CMS is changing the algorithm to the staffing dimension rating. Some facilities will begin reporting on staffing within calendar year (CY) 2015, with all nursing homes reporting on this measure within CY 2016.

The staffing data points will largely come from your payroll system. CMS officials said on the ODF call that they’re currently working on deriving data from different types of payroll systems.

Resources: CMS has posted an updated Technical Users’ Guide for the Five-Star Quality Rating System, which you can access at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/usersguide.pdf. CMS also updated the Consumer Fact Sheet: www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/consumerfactsheet.pdf. You can find other updates as CMS posts them on its Five-Star Quality Rating System webpage at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html.