19
Shooting Stars and Deadline Landmines: A
Summary of the 2018 Nursing Home Compare
Five-Star Quality Rating System Changes
By Susan Chenail, RN, CCM, RAC-CT, senior quality improvement analyst
2018
may have brought the most
comprehensive revamp of the
Five-Star Quality Rating System since 2015. All three
domains will be updated this year. The changes include
new methodologies to calculate both the health
inspection and staffing domains. The quality measure
domain is due for updates before the end of the year.
The changes also include a new short-stay pressure
ulcer quality measure that replaces the pressure ulcer
measure that used the recently discontinued Minimum
Data Set (MDS) items M0800 and the annual quality
measure cut point adjustment.
This past spring, the methodology used to calculate the
the
health
inspection
domain
clarified.
Essentially,
health
inspection
domain
was was
clarified.
Essentially,
the
the
Centers
for Medicare
Medicaid
Services
(CMS)
Centers
for Medicare
and and
Medicaid
Services
(CMS)
clarified
clarified
how
it was
to the
manage
the “freeze.”
CMS
how it was
going
to going
manage
“freeze.”
CMS defined
defined
the number
of surveys
used
– the
two
most prior
the number
of surveys
used – the
two
most
recent
recent
to Nov.
28, their
2017 weighting
– and their
weighting
to Nov. prior
28, 2017
– and
factor:
60 and 40
factor:
and the
40 most
percent,
with survey
the most
recent heavier.
survey It
percent, 60 with
recent
weighted
weighted
heavier.
It also defined
timeframes
from
also defined
the timeframes
from the
which
complaints
would
which
complaints
would
used:
Nov. for
28, calculation
2015 to Nov. in the
be used:
Nov. 28, 2015
to be
Nov.
27, 2016
27,
2016 most
for calculation
in the
second
most
second
recent survey
period,
and
Nov. recent
28, 2016 to Nov.
survey
and Nov. in 28,
2016
to recent
Nov. 27, survey
2017 for
27, 2017 period,
for calculation
the
most
period. The
calculation
in the most
survey period. CMS
The anticipates
aging
aging of complaints
has recent
been discontinued.
of
been to
discontinued.
anticipates
the complaints
end of the has
“freeze”
occur in the CMS
spring
of 2019.
the
end
of
the
“freeze”
to
occur
in
the
spring
of
2019.
The staffing domain was also overhauled. All three
calculate resident acuity. Several facilities, including
those in New York, felt the effect of shooting stars.
Some stars were lost, and some were gained, but most
were unchanged.
Summer brought the one-star penalty definitions
used in the staffing domain. This is a serious penalty
because scoring one star in staffing reduces a facility’s
overall rating by one star, leaving some feeling as
though they stepped on a landmine. There are three
occasions that will cause a facility to score one star in
the staffing domain: (1) if the facility fails to submit its
PBJ data by the reporting deadline; (2) if the facility
reports seven or more days with no Registered Nurse
(RN) staffing; and (3) if the facility fails to respond
to a staffing audit, or the results of the staffing audit
identify significant discrepancies between the reported
hours and the hours verified. An easy way to sidestep
a deadline landmine is to submit PBJ data on time. To
access a PBJ quick reference tool, click here.
In October, the new MDS 3.0 v 1.16 item sets were
put in use along with the updated RAI Manual. To go
hand in hand with the new, revised and retired items,
aspects
included
in the
of this All
domain
The
staffing
domain
was calculation
also overhauled.
three
were updated:
the in number
of staff, of
census
and
aspects
included
the calculation
this domain
were
acuity
of
the
resident.
CMS
used
Payroll
Based
updated:
number of staff, census and acuity of the
Journal (PBJ)
to Payroll
calculate
nursing
hours,
the
resident.
CMS data
used
Based
Journal
(PBJ)
data
MDS
to calculate
census
and
Utilization
to
calculate
nursing
hours,
the Resource
Groups (RUGs)
IV to
Adviser a publication of LeadingAge New York | Fall 2018