CMS to Publicly Post PBJ Data

By Jillian Martin and Carl Moellenkamp

In 2008 the Centers for Medicare and Medicaid Services (CMS) implemented a tool to assist consumers in evaluating nursing homes. The Nursing Home Compare website was developed and updated by CMS to provide an overall rating to all Medicare and Medicaid certified nursing homes in the United States.

For further information, users should review the Five-Star Technical Users’ Guide or the MDS 3.0 Quality Measures User’s Manual. A new version of the second document with the new QM data and methodology was published in April 2016.

The Five-Star Quality Rating System was developed as an easy-to-understand rating system for consumers. In the years since its development, however, the data has been used by hospitals to determine referral sources, by nursing homes for peer comparison, and by managed care organizations to determine contract feasibility. State regulatory agencies have also found value in the information provided by the system.

The system is easy to understand once the ratings are assigned, but arriving at that rating is a complex process.

The composition of the rating system
Three separate domains contribute to the overall rating:

  • Health inspection — Based on outcomes from state health inspections
  • Staffing — Based on nursing home staffing levels
  • Quality measures (QMs) — Based on minimum data set (MDS) and claims-based QMs.

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