CMS Moves the Goalposts for Five Star Ratings

Many facilities will lose a Staffing star due to how CMS increased emphasis on RNs in the Staffing Five Star ratings. 

In this March letter to State Survey Agency Directors and related updates to the Five Star Users Guide, CMS announced a series of changes to Nursing Home Compare and Five Star ratings including:

  • Changes to the Staffing Five Star (read below)
  • The end of the Nov 2017 freeze on Health Inspection ratings
  • Changes to Quality Measures including new short stay and long stay measures

Monitor the impact of these two Staffing Five Star changes when the new PBJ Five-Star ratings are published next week (late April):

(1)  Daily RN Coverage Rule Tightened
Currently, SNFs can trigger an automatic one star for staffing if they report seven (7) or more days with zero (0) RN hours in a quarter.  Beginning with the next PBJ submission, this threshold is now just four (4) or more days.  ezPBJ's error checker has already been updated to this new rule.

(2)  Five Star Cut Points and Weighting Shifted
Less obvious is the shift in RN cut points and stars in the Staffing Five Star table.  The focus on RN staffing comes from:

  • A major shift in RN cut points - from 18% to 31% higher HPRD per star level
  • Change in Star levels emphasizing RN's (see image)

These changes are RETROACTIVE.  The Oct 1 to Dec 31 PBJ report (submitted by Feb 14th) will be the first to use these new cut points when the Staffing Five Star ratings comes out next week.

We recommend you assess your staffing levels and use ezPBJ to monitor your real-time Hours Per Resident Day metrics. Knowing what's coming enables you to plan your staffing to respond to the latest focus on RNs.