Long-term care facilities are also in constant pursuit of a much-desired five-star rating. The Centers for Medicare & Medicaid Services (CMS) developed the Five-Star Quality Rating System as a tool for consumers to compare nursing homes and make better-informed decisions. Consumers can visit the Medicare Nursing Home Compare website to research the ratings for different facilities in their area. Each facility’s rating is based on health and safety inspection data, staffing information, and 11 different quality measures (QMs). However, recent changes to the system – along with the Payment-Based Journal (PBJ) requirements – may modify the scenarios for how facilities earn their ratings.

Addressing the Rating and PBJ Changes

CMS recently introduced six new QMs, five of which will be gradually phased into the rating system through January 2017. These claims- and Minimum Data Set (MDS)-based measures include percentages of:

• successful discharges to the community,

• residents whose functioning abilities have improved,

• re-hospitalized residents,

• outpatient ER visits of discharged residents, and

• patients whose ability to move independently has declined.

These QMs will require facilities to sharpen their focus on the accuracy of claims, design processes to track and monitor discharges, and document residents’ movements.

Another notable change, which began in July 2016, is the nationwide mandate for long-term care facilities to electronically submit census and direct care staffing information every quarter through the PBJ system. While this system is designed to enable nursing homes to collect more accurate staffing data, preparing for the changes may require some facilities to invest in additional software and staff.

Just as some athletes have a winning formula, CRI has a recipe for PBJ reporting success. Does your facility have all of the necessary ingredients?

What Does a Five-Star Rating Mean?

A nursing home’s five-star rating does not guarantee a safe and comfortable stay for residents or profitability for the organization. Facilities should closely monitor their ratings and QM reports for improvement opportunities. Ideally, these opportunities will help nursing homes either maintain or achieve a five-star rating. High ratings will become even more important as Medicare moves to quality-based payment models, which – in worst-case scenarios – could force the lowest rated facilities out of the game.

CRI Can Help You Prepare for the Five-Star Quality Rating System Changes

Nursing homes need proper training on how the changes to the Five-Star Quality Rating System can affect their performance on the field. CRI’s healthcare team is ready to not only assist you through those updates, but also guide you in incorporating them into your operations to improve patient care. Contact us if you need help designing and implementing a system to more effectively monitor and improve your rating.