CMS will implement updates to the Nursing Home Compare tool and Five-Star Quality Rating System starting April 2019.

The article discusses the changes to the Nursing Home Compare website and the Five-Star Quality Rating System used by the Centers for Medicare and Medicaid Services (CMS). The updates aim to provide a more accurate reflection of nursing home quality and resident care.

Key Changes:

1. Weighting of measures: The scoring rules for quality measures have been changed to give more weight to those with greater opportunity for improvement.

2. New point thresholds: New point thresholds have been established for the overall quality measure rating, as well as short-stay and long-stay ratings.

3. Additional measures: Measures of long-stay hospitalizations and long-stay emergency department visits have been added to the quality measure rating.

4. Removal of physical restraints measure: The long-stay physical restraints measure has been dropped from the quality measure rating.

Impact on Star Ratings:

Facilities may see a change in their overall star rating due to various reasons, including:

1. Changes in health inspection data
2. Updates to staffing measures and ratings
3. Changes in quality measures

Health Inspection Rating Changes:

Events that could change the health inspection score include:

1. New health inspections
2. New complaint deficiencies
3. Revisits (second, third, or fourth)
4. Resolution of Informal Dispute Resolutions (IDR) or Independent Informal Dispute Resolutions (IIDR)
5. Aging of complaint deficiencies

Staffing Rating Changes:

Changes in staffing measures and ratings may be due to:

1. Differences in the number of hours submitted for staff
2. Changes in daily census
3. Changes in resident case-mix from the previous quarter

Quality Measure (QM) Rating Changes:

A set of quality measures has been developed to describe the quality of care provided in nursing homes. These measures address a broad range of function and health status indicators. Changes in the quality measures may change the star rating.

The updates typically occur quarterly, and technical specifications for all measures are available on the CMS website.