How to Improve Your CMS 5 Star Rating: 5 Tips
The Centers for Medicare and Medicaid Services (CMS) 5 star rating, also referenced as CMS five star rating, was created to help people select a safe and high-quality nursing facility. The influence of this rating system has grown — impacting how the government, health insurance companies, lenders, and investors determine incentive payments, referrals, and financial loans. While this article focuses on nursing homes, similar versions of this rating system have extended to hospitals, home health agencies, and dialysis centers.
Your facility knows first-hand how CMS star ratings affect your reputation, success in attracting prospective residents, and your finances due to government incentives or penalties. This article aims to improve your experience and help you earn high stars by providing insight into CMS scoring methodology and offering tips on how to improve your ratings.
CMS Star Rating Methodology
The CMS 5 star rating system methodology used to evaluate nursing facilities is comprehensive, assessing extensive criteria through multiple data sources. CMS calculates your facility’s stars by considering three domains:
- State health inspections
- Quality measures
Each domain earns an individual score and factors into the overall quality rating. Unless otherwise noted, the information provided in this methodology section comes from the CMS Nursing Home Compare Technical Users’ Guide.
1. State Health Inspection Measures
The three most recent inspection surveys, verified complaint investigations, and focused infection ratings within the past three years determine the score for this domain. Federally trained state inspectors perform unannounced visits approximately every 12 to 15 months to evaluate compliance with state and federal regulations.
The amount, scope, and severity of deficiencies and the length of time for a facility to correct these deficiencies are factored heavily in the scoring. Stars for health inspection measures are allotted by how each facility ranks compared to other facilities in that state.
If a facility has an abuse citation, the maximum rating those facilities can earn for that health inspection is two stars. The Nursing Home Compare website, which also posts complaints under investigation, highlights the citation with an abuse icon.
2. Staffing Measures
The government recognizes the relationship between poor nurse staffing and high nurse turnover rates, decreased resident quality of care, and poorer outcomes. As a result, the CMS 5 star rating evaluates six measures divided into three nurse staffing measures and three staff turnover measures, assigning the most points to safe staffing.
The data your facility submits to the government through the Payroll-Based Journal (PBJ) System and the Minimum Data Set, Version 3.0 (MDS 3.0) assessments determine your rating in this domain. Not meeting the strict collection criteria and deadlines results in a one star staffing rating for the quarter.
3. Quality Measures
CMS has identified a set of 15 measures for short- and long-stay residents that define the quality of care found at your facility. The measures are assessed with available data from the past four quarters derived from the MDS 3.0 and Medicare claims data and are typically risk-adjusted into three quality measure (QM) ratings: short-stay, long-stay, and an overall score.
Overall Quality Rating
Once the star ratings have been determined, CMS assigns the overall rating. The calculation uses the health inspection rating as the foundation, provided by the most recent findings from an onsite visit. Stars are added or subtracted from the health inspection rating based on how the nursing home performed on staffing and quality measures. The overall score can’t be less than one star or more than five stars.
Five Tips to Improve Your CMS 5 Star Rating
Now that the review of the CMS methodology is complete, you’ll learn to strategically use the following tips at your facility to help secure that exclusive symbol of healthcare excellence: the CMS five star rating.
1. Assess Compliance
The surveyors thoroughly audit your compliance with government regulations during your facility’s health inspection. Have your healthcare administrator or director of nursing (DON) prepare by conducting an internal audit to address any issues with a well-considered plan. You’ll want to earn top marks, as this score heavily impacts the overall quality rating.
Develop an urgent corrective action plan if a recent health inspection cited any deficiencies. The surveyors will be back to assess if you have resolved their concerns. Problems not resolved promptly result in multiple visits and will hurt your score.
2. Address Nurse Staffing
If you didn’t score well in this area of the CMS 5 star rating, work with your nursing leadership to address any staffing pain points. Nurses are looking for flexibility and work-life balance. If you don’t have the resources to offer staffing strategies and solutions, look for a trusted staffing partner to provide this service.
As you build up your nursing team, work together to implement a plan to decrease burnout among nursing staff and decrease the turnover rate at your facility. This long-term investment will take time to implement; however, it will ultimately yield results that improve nursing satisfaction, patient outcomes, and resident quality of life.
One way to address deficiencies related to understaffing is to train and hire caregivers, who can help residents with activities of daily life. They’re not authorized to do everything a CNA does, but they can help free up staff for more high-level tasks.
3. Prioritize Quality Measures
Quality measures (QMs) improve patient outcomes and quality of care. Based on the long list of QMs that CMS evaluates, it may be unclear where to begin. Start with the measures with the lowest scores from your last visit and prioritize the QMs assigned the most points, as this will significantly impact patient outcomes and your score.
Lead your staff in a nurse hackathon, where you identify issues and problem-solve solutions impacting your QM scores as a team. Often, practical and cost-effective solutions are available by engaging your nursing experts.
4. Prevent Elder Abuse
Senior adults are vulnerable and at risk for abuse and neglect. Incidents of abuse can result in resident injury and significantly impact your CMS 5 star rating. With proper training, nursing homes can prevent and reduce resident harm in their facilities, improving the health and safety of their residents. By listening to nursing staff and utilizing available resources, you can gain insight into additional educational needs, such as the use of calming and de-escalation techniques with confused or agitated residents or clinical training on dementia and Alzheimer’s disease.
5. Implement Standards and Policies for Residents With Mental Illness
CMS has found that residents were incorrectly assigned schizophrenia diagnosis codes in resident MDS 3.0 assessments. As a result, coding inaccuracies for schizophrenia are now incorporated in the CMS 5 star rating measures. Medicare will penalize facilities for errors by suppressing or reducing QM ratings for six to 12 months, potentially resulting in a loss of stars.
By working with your medical director and psychiatric practitioners, your facility can implement standards and processes to ensure correct mental illness diagnoses and review the use of long-standing antipsychotic medications, another CMS QM. This will enhance patient outcomes by providing proper treatment and improving the quality of care for residents.
Interested in Learning More About Improving Quality Ratings?
Improving and maintaining a high CMS 5 star rating is an ongoing pursuit. As a healthcare leader, you constantly search for practical ways to enhance quality and outcomes. Learn more about new and innovative ideas to improve care at your facility, with insights delivered to your inbox.