Long-term care facilities are also in constant pursuit of a much-desired five-star rating. The Centers for Medicare & Medicaid Services (CMS) developed the Five-Star Quality Rating System as a tool for consumers to compare nursing homes and make better-informed decisions. Consumers can visit the Medicare Nursing Home Compare website to research the ratings for different facilities in their area. Facilities earn their ratings through their 3 most recent health inspections, staffing data submitted through the Payroll Based Journal (PBJ), and 17 different Quality Measures (QMs) which offer information about how well nursing homes are caring for their residents’ needs. There is one overall 5-star rating for each nursing home, and separate ratings for each of the three submission sources.

Addressing the Rating

CMS introduced the QMs in 2017. Ratings are based upon the performance of ten long-stay measures and seven short-stay measures and are derived from claims- and Minimum Data Set (MDS)-based data that facilities collect on residents at specified intervals during their stay. The measures assess the resident’s physical and clinical conditions and abilities, as well as their particular daily life style wishes. These QMs require facilities to sharpen their focus on the accuracy of claims, design processes to track and monitor discharges, and document residents’ movements.

The payroll-based journal, which began in 2016, is the nationwide mandate for long-term care facilities to electronically submit census and staffing information every quarter through the PBJ system and has information about the number of hours of care provided on average to each resident each day based upon the levels of residents’ care needs. The system is designed to allow CMS to collect more accurate staffing data, and facilities must be prepared to collect the data accurately which may require some facilities to invest in additional software and staff.

Just as some athletes have a winning formula, CRI has a recipe for PBJ reporting success. Does your facility have all of the necessary ingredients?

What Does a Five-Star Rating Mean?

A nursing home’s five-star rating does not guarantee a safe and comfortable stay for residents or profitability for the organization. Facilities should closely monitor their ratings and QM reports for improvement opportunities. Ideally, these opportunities will help nursing homes either maintain or achieve a five-star rating. High ratings will become even more important as Medicare moves to quality-based payment models, which – in worst-case scenarios – could force the lowest rated facilities out of the game.

CRI Can Help You Prepare for the Five-Star Quality Rating System Changes

Nursing homes need proper training on how the changes to the Five-Star Quality Rating System can affect their performance on the field. CRI’s healthcare team is ready to not only assist you through those updates, but also guide you in incorporating them into your operations to improve patient care. Contact us if you need help designing and implementing a system to more effectively monitor and improve your rating.