CMS Implements More Rigorous Standards for Nursing Home Five-Star Rating System

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The Centers for Medicare & Medicaid Services (CMS) has implemented more rigorous standards for the Five-Star Quality Rating System for nursing homes. The standards now require additional data from hospital readmissions, a lower threshold for staffing penalties, and separate evaluations for short-term and long-term stays. The star-rating overhaul aims to improve the quality of care at nursing facilities around the country, in addition to improving the reliability of ratings, and comes as a response to criticism of CMS for being too lenient in the past.

Prior to these new standards, improvements in star ratings did not necessarily correlate with fewer preventable hospitalizations. Because the old rating system focused on long-term care, as opposed to short-term, post-acute care, nursing facilities could implement a change that improved the star-rating but did not improve actual outcomes. The overhaul targeted this inconsistency by not only including hospitalization data, but also implementing separate rating systems for short-term care and long-term care.

To help improve overall quality of care for both short- and long-term residents, and lower hospital readmissions, proper staffing is crucial. Nurse staffing has the greatest impact on care, evident by an analysis from CMS that found as staffing levels increase, quality of care increases. Therefore, CMS will automatically give nursing homes a one-star staffing rating if they exceed four days in a quarter with no registered nurse on site, lowered from the previous seven-day standard.

Staffing issues in nursing homes became a central issue following a New York Times and Kaiser Health News publication on facilities overstating their staffing levels in their reports to CMS. The data supplementing the publication indicates that CMS' five-star rating system for nursing homes has given providers an opportunity to exaggerate staffing levels and seldom identified the periods of thin staffing that were common, especially on weekends.

In response to the publication, CMS is now using Payroll-Based Journal data to direct inspections of facilities presumed to have insufficient staffing, replacing nursing homes' previously self-reported and unverified staffing information. Additionally, CMS gave 1,400 nursing homes one-star ratings in staffing because there was not a registered RN on site for four or more days in a quarter. CMS' new star-rating system is designed to incentivize continuous and sustainable quality improvement among skilled nursing facilities (SNFs).

Chronic understaffing is one of the greatest causes of injury and neglect in skilled nursing facilities, often leading to increased hospitalizations and preventable negative health outcomes. If you feel that you or a loved one has been harmed at a nursing home, contact Daniel, Holoman & Associates LLP. We have attorneys licensed in North Carolina, Kentucky, Georgia, and Tennessee, and there is no charge to speak with someone about your matter. We offer contingency fee arrangements to handle cases with merit (in other words, you don't pay unless we recover).


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