36% of Skilled Nursing Facilities See Star-Rating Declines After CMS Changes Take Effect

Roughly 36% of skilled nursing facilities saw a drop in their overall star ratings after planned changes to the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare system took effect on Wednesday.

That’s according to a pair of analyses from the American Health Care Association (AHCA), a trade group representing nursing homes, and CarePort, a firm that provides software aimed at improving transitions of care between the acute and post-acute setting.

AHCA pegged the drop at 36%, while CarePort found about 37% of providers saw a decline in their overall Five-Star Quality Rating System metric, director of post-acute care analytics Tom Martin told Skilled Nursing News.

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About 16% of providers gained at least one star under the ratings overhaul, according to CarePort, while AHCA found about 15% of providers saw a boost. Approximately 47% of skilled nursing facilities had no change in their overall rating, but slightly more lost one or more stars on the quality measure, Martin told SNN.

“Roughly 48% of providers lost one or more stars in the quality domain, and that’s largely driving the decrease in overall stars,” he said.

It’s important to note that care didn’t necessarily get worse just because a facility’s score dropped with the ratings overhaul, Martin noted in comments e-mailed separately to SNN.

A building’s five-star score consists of three separate metrics, each of which CMS also ranks from one to five: survey, quality, and staffing, with recent changes to the calculations making it harder for providers to get above average ratings. In AHCA’s assessment, 47% of buildings lost at least one star on quality, with 33% seeing a drop of one star or more on staffing and 23% relinquishing at least one survey star.

Staffing had taken center stage in CMS’s ratings overhaul, particularly after a New York Times investigation last summer revealed that operators may have been less than accurate in reporting nurse coverage information. Federal officials responded by slapping 1,400 facilities with automatic one-star ratings on staffing.

When rolling out this most recent set of requirements back in March, CMS lowered the threshold for receiving a single staffing star: Instead of seven or more days per quarter without a registered nurse on site, operators now face the lowest mark if officials find fewer than four days.

But Martin recommended that providers focus on their quality metric first if they want to improve their overall star rating. Both the staffing measure and the survey measure are important, with survey having the most weight, he added. Still, practically speaking, providers receive one standard survey a year. And improving staffing will require extra funds coming in from somewhere, as well as the effort of finding competent employees in a major workforce crunch.

Improving a SNF’s quality metrics, however, can begin much more quickly.

“The first thing I’d want to do as a provider is identify where I fall across those CMS cut points,” Martin told SNN, referring to the scoring thresholds CMS lists in its user guide tables, based on the percentage of metrics they meet. “If I fall short [somewhere], that’s a place to focus on … Making an improvement on a measure where you’ve already maxed out the points is not really going to change the star rating.”

SNFs can also take steps to improve how they keep track of patients when they are discharged. Readmission penalties are assessed 30 days after hospital discharge, Martin noted, and so SNFs could be on the hook for any complications that arise after a patient leaves their care.

“What we want to encourage providers to start doing is to think about ways they’re tracking patients outside the care setting,” he told SNN. “Because unfortunately it’s not just something they can do in their facility anymore.”

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