CMS Updates Five-Star Quality Rating System Technical Users' Guide

In July 2016, the Centers for Medicare & Medicaid Services (CMS) is making several changes to the quality measure (QM) domain of the Five-Star Nursing Home Quality Rating System. These include the addition of five new measures and several methodological changes. The new measures are:

• 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 were re-hospitalized after a nursing home admission (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)

These measures greatly expand the number of short-stay measures used on Nursing Home Compare and add important domains not covered by other measures.

The five new QMs will be phased in between July 2016 and January 2017. In July 2016, they will have 50% 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.

These changes are described in more detail in the Quality Measure Domain section of the updated manual.  

Contact: Kathy Pellatt, kpellatt@leadingageny.org, 518-867-8848