An Update on Five-Star Changes

AHCA reports that on last week’s Centers for Medicare & Medicaid Services (CMS) Open Door Forum call, CMS reported that starting on July 27 at 10 AM ET the Quality Measure (QM) component of the Five-Star Rating System will reflect five of the six new QMs that are currently featured on Nursing Home Compare (NHC). The agency announced in March that this change was going to happen in July. For a summary of that presentation and a list of the six new measures, click here.

CMS also announced that it has posted an updated Technical User’s Guide on its website here. On the second page of the guide, there is a short list of the overall changes you can expect. Below are the key changes outlined in the guide:

• The five new QMs will be phased in between July 2016 and January 2017.
• In July 2016, they will have 50 percent of the weight of the current measures.
• In January 2017, they will have the same weight as the current measures.
• The methodological changes that will be introduced in July include:
  • Using four quarters of data rather than three for determining QM ratings.
  • Reducing the minimum denominator for all measures (short-stay, long-stay, and claims-based) to 20 summed across four quarters.
  • Revising the imputation methodology for QMs with low denominators meeting specific criteria. A facility’s own available data will be used and the state average will be used to reach the minimum denominator.
  • Using national cut points for assigning points for the ADL QM rather than state-specific thresholds.

AHCA recommends that members review the guide for more details.

In addition, the agency is making changes to the CASPER provider preview report. The revised report will incorporate the new measures, display updated star ratings, and include a new column that shows the points assigned to each QM for a better understanding of the quality rating.  All skilled nursing care centers will have access to their preview reports through the QIES System by the end of next week.

At this time, AHCA does not know how the new QMs may impact your star rating. For example, the number of stars that may be lost or gained.

On Thursday, July 28 at 3 PM ET, AHCA will host an all-member webinar to walk through these changes and answer questions. Please register here. 

In the meantime, members should continue to take steps to prepare for these upcoming changes. Resources, including the updated Technical User’s Guide, are available on the members-only Five-Star ahcancalED website here. The AHCA Quality Initiative website here, along with blog posts here and here, provide additional tips and information.

If you have any questions, please contact AHCA at dgifford@ahca.org.