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Medicare makes Five Star Rating System for nursing homes even tougher

Climb gets even steeper for nursing homes to reach a five star rating

Feb. 23, 2015 - The Centers for Medicare & Medicaid Services (CMS) says it has strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to “give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one.” The changes appear to make the hill even steeper to climb for nursing homes to reach the top ratings.

Beginning today, nursing home star ratings will:

  ● Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.

  ● Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.

  ● Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.


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The announcement Friday by CMS, says this also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, as the Administration announced last October.  

Star ratings allow users to see important differences in quality among nursing homes to help them make better care decisions. CMS rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS uses these three categories to offer an overall star rating, but consumers can see and focus on any of the three individual categories.

“CMS is committed to improving Nursing Home Compare and the Five Star Quality Rating System to ensure they are the most trusted and easy-to-use resources we can provide,” said Patrick Conway, M.D., CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS. “Consumers can feel confident that Nursing Home Compare’s star ratings include measures that matter most to nursing home residents and their families and challenge nursing homes to continuously improve care.”

Since CMS standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating.  By making this change, Nursing Home Compare will include more meaningful distinctions in performance for consumers and focus nursing homes on continuously improving care focused on residents, families, and their caregivers. About two thirds of nursing homes will see a decline in their quality measures rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating.

For example, before the recalibration, about 80 percent of nursing homes received either a 4 or 5-star rating on their quality measures. Now, about 49 percent of nursing homes will receive a 4 or 5 stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the recalibration.

CMS is also focusing changes in areas identified by consumers and other stakeholders as important. For example, by the end of 2013 nursing homes achieved a 15 percent reduction in the use of anti-psychotics compared to 2011 levels. As part of the National Partnership to Improve Dementia Care, CMS is working with the nursing home community, patients, families and other important stakeholders to achieve a 30 percent reduction by the end of CY2016.   

The Nursing Home Compare website was launched in 1998, and CMS added the Five Star Quality Rating SystemNH Compare 2.0”) in 2008.  Nursing Home Compare gets approximately 1.4 million visits per year and users report high satisfaction with the site. More than 85 percent of users have indicated that they found the information they were seeking. CMS recommends that consumers rely on multiple factors – including star ratings, visits and community reputation -- when selecting a nursing home.

To achieve better care, smarter spending and healthier people, the Department of Health and Human Services is focused on sharing information more broadly to providers, consumers, and others to support better decisions while enforcing patient privacy. The Five Star Quality Rating System for Nursing Homes is part of an administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making by consumers.

  ● Read a fact sheet on Nursing Home Compare 3.0 .

  ● Search for nursing homes in local areas, visit .

  ● More information on the national partnership. pdf

  ● More information on the Advancing Excellence campaign.

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