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New Rules to Five Star Keep Nursing Homes on Their Toes

A new stringent system is waiting to be implemented by the Centers for Medicare & Medicaid Services to Nursing Home Compare that will lower the cut-off points regarding the attainment of certain star levels. The system calls for 11 new quality measures that threaten to jeopardize star ratings of as many as 15% of nursing home facilities that could result in their immediate loss of one or two stars. The CMS has not yet disclosed exactly how many facilities will be affected. However, the matter will be discussed at its Skilled Nursing Open Door Forum today, at 2 p.m. ET.

Whether the Five Star recalculation plan will be established immediately or gradually is uncertain. Moreover, the effect the new scores will have on skilled nursing facilities affiliated with accounted care organizations or managed care contracts is still unclear.

There is also potential for staffing levels to be recalculated. Nursing home facilities have often been criticized for their corrupt staffing practices (a recent New York Times article has brought this to public attention). A quarter of nursing home facilities have been accused of inflating self-reporting registered nurse staffing levels on Nursing Home Compare.

The fact that CMS will also be adding measures for short-stay and long-stay antipsychotic use to the ratings model is certain. Both major long-term care organizations have voiced their approval. It has been confirmed by CMS Chief Medical Officer Patrick Conway, M.D., that antipsychotics measurements will be included in the Five Star system by the fall of 2015.   This reduction of antipsychotics is not only supported by Leading Age Senior Vice President of Advocacy Cheryl Phillips, M.D., but also by the American Health Care Association/National Center for Assisted Living. AHCA/NCAL wants to avoid skilled nursing facilities from re-basing on the original Five Star curve so that families and residents do not get the wrong impression that skilled nursing facilities’ quality of care is diminishing when, in fact, almost “every quality marker—both in and outside of Five Star—point to quality improving in [its] centers nationwide,” says AHCA spokesman Greg Crist.