The Centers for Medicare & Medicaid Services (CMS) recently made significant changes to their star-rating standards.
Following inspections taking place after the more rigorous standards were implemented in April of 2019, an assessment by The American Health Care Association (AHCA), a trade company representing nursing homes, found that roughly 36% of skilled nursing facilities (SNFs) saw an overall drop in ratings. CarePort, a firm that provides software to improve transitions of care between the acute and post-acute setting, found a 37% drop in overall SNF ratings in their assessment. A nursing home's five-star score consists of three separate metrics: quality, health inspection survey, and staffing, each being scored on a scale of one through five. The AHCA found that 48% of facilities lost at least one star on quality, while 33% saw a drop of one star or more on staffing and 23% lost at least one health inspection survey star.
One of the greatest reasons for the decrease in overall star-ratings comes from the lower scores in the quality domain, with 48% of facilities losing one or more stars in this area.
Staffing issues became a priority after a New York Times publication indicated that administrators may be overreporting nurse coverage in facilities, which prompted CMS to lower the threshold for one-star staffing ratings. The new requirement lowered the maximum number of days without a nurse on site from seven days to four days before the facility receives an automatic one-star rating on staffing.
SNFs may also still be liable for complications that arise after a patient leaves their facility. Readmission penalties are assessed 30 days after hospital discharge, so facilities are encouraged to track their patients outside of the care setting.
The decrease in ratings already indicates that the new system from CMS has the potential to stimulate improvement in care at nursing facilities. Higher ratings often mean more hospital partnerships and more patients, so facilities would be wise to improve their care in order to improve their ratings. Regardless, preventable injuries are still commonplace in nursing settings. If you believe that you or a loved one has been harmed in a nursing facility, contact Daniel, Holoman & Associates LLP. There is no charge to speak with someone about your case, and if we take your case we are paid only if we recover money.