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Five Star Rating System Changes

Posted Apr 1, 20192 min Read

Regulatory & Clinical

There are several significant changes to the Five Star Quality Rating System.  There will be adjustments to all three domains of the Five Star Quality Rating System –Health Inspections, Staffing and Quality Measures as follows:

Health Inspection Domain

  • April 2019 the freeze will be lifted.
  • The star rating calculation for Health Inspection domain will be based on three cycles of inspections and will now include inspections on or after November 28, 2017.
  • Pre-freeze weighting will be used to determine scores; however, star ratings will now be suppressed for facilities included in the Special Focus Facilities Program (SFF).

Staffing Domain

  • Effective April 24, 2019, facilities that report four or more days in a quarter with no RN on site will be automatically downgraded to a one-star rating in staffing domain.
  • This is a significant change and will impact many already feeling the widespread workforce challenges related to the RN staffing shortage.

Quality Measure Domain

  • New QM rating threshold that will be raised.  This change goes together with the QAPI requirements of participation which requires facilities to show continuous as well as greater rates of improvement.
  • Thresholds will increase by 50% every six months.  This means a facility will need to continue to improve to maintain or improve ratings.
  • Separation of short-stay and long-stay ratings.  Data from both will now be evaluated separately.
  • Long-stay resident data will now include hospitalization rates and emergency department transfers, but no longer include the use of physical restraints.
  • QM weightings and scoring will now be identified as “high” weight and “medium” weight.
  • QMs of high weight – 150 points – awarded in 10-point increments
  • QMs of medium weight – 100 total points – awarded in 5-point increments

Recommended Action:

  • Participate in AHCA Webinar, ” The Stars are Changing – What Will Happen to Your Five-Star Rating?” scheduled for April 8, 2019 from 12:30 – 1:30 p.m. EST.
  • Utilize the LTC Trend Tacker Five Star Predictor Tool to mitigate risk.
  • Ensure QAPI program is in place by November 2019.
  • Ensure Clinical programs are being managed from admission and throughout a resident stay.
  • Ensure Orientation and on-going training of staff is in place and includes pertinent information.
  • Contact IHCA staff fir assistance and or training as needed.