Extra CMS Stars Decrease Chances of Long-Term Nursing Stays

Post-acute residents in skilled nursing facilities with excellent quality ratings are much less likely to transition to long-term care (LTC) than those in lower-quality SNFs, according to a study published last week in the Journal of the American Geriatrics Society.

“Individuals in SNFs with excellent quality ratings had 22% lower odds of transitioning to LTC than those in SNFs with poor ratings,” the study authors wrote.

The study examined 552,414 fee-for-service Medicare beneficiaries discharged to a SNF from a hospital in 2013, with participant characteristics taken from Medicare data and the Minimum Data Set (MDS). The outcome measurement was a stay of 90 days or more in an LTC nursing home within six months of an admission to a SNF.


For ratings, it used the Centers for Medicare & Medicaid Services (CMS)’ Five-Star Ratings from Nursing Home Compare Ratings files.

Overall, the rate of post-acute residents who transitioned to LTC beds within 90 days of a hospital discharge was 10.4%.

“There were clear stepwise relationships between odds of LTC and quality ratings,” James Goodwin of the University of Texas Medical Branch and colleagues wrote. “SNF residents with excellent ratings had 22% lower odds of LTC placement than SNF residents with overall poor ratings. When the CMS ratings were separated into their three components, staffing ratios and inspections were strongly related to LTC placement rates, with quality measures less strongly related.”


The SNF where a participant received care explained 7.9% of the variance in the risk of transitioning to LTC, after adjusting for participant characteristics; the prior hospital explained 1%, the study also found.

While the Five-Star system doesn’t always convey the full picture of a SNF and has come under criticism for inaccuracies and susceptibility to manipulation, the study findings show that the ratings can provide useful insight.

“When the Five‐Star SNF rating was deconstructed into its three components, we found that staffing ratios and inspections were most closely associated with LTC placement rate,” the authors emphasized. “It is reasonable to believe that more nursing staff per resident would result in fuller recovery and lower risks of LTC placement. SNFs also vary in outcomes such as mortality and readmission rates, which are also associated with quality ratings, although more weakly than the association with LTC placement rates.”

The researchers recommended further work on the SNF processes that explain the variation in risk of LTC nursing home placement.

Written by Maggie Flynn

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