New Quality 5-Star Measures

Currently, every nursing home is continuously being branded with its own overall 5-star rating by the Centers for Medicare & Medicaid Services (CMC).

This forced ranking system used to be a derivative of three separate analytical sources:  health inspections (prior 3 years), staffing and QMs-quality measures (Nursing Home Compare combines 16 QMs, a subset of the 24 QMs listed on Nursing Home Compare) to create a providers QM rating. QMs are derived from clinical data reported by each nursing home and are compared across the country and to every other nursing home by state respectively on Nursing Home Compare (Medicare.gov). This rating system provides the public with profound insights into the quality of care and outcomes to expect from providers.

Effective April, 2016 CMS added six new QMs, five are implemented now and the sixth involving antianxiety/hypnotic medication use is being postponed. These metrics are evident on Medicare.gov and consist of:  % of short-stay residents who were successfully discharged to the community, % of short-stay residents who have had an outpatient emergency department visit, % of short-stay residents who were re-hospitalized after a nursing home admission, % of short-stay residents who made improvements in function, % of long-stay residents whose ability to move independently worsened and the % of long-stay residents who received an antianxiety or hypnotic medication.

In summary, understanding the metrics behind the Medicare 5-star rating system can mean the difference between accepting substandard care and receiving the exceptional clinical care and specialty quality services our loved ones deserve. To gain further discernment into this rating system, log on Medicare.gov, Official U.S. Government Site for Medicare, and click on Spotlight in the bottom left or on find nursing homes to reveal details of their measures. Whereas no system could guarantee a consumer with any level of care, it does provide consumers a vivid breakdown of what can be expected and what others experienced. Consumers would be best served to utilize this five star rating tool alongside other sources of information and an in-person visits to better determine which provider to trust and would be most suitable for their health needs.

Editor’s Note: Submitted by Gerry Lafont MPA, NHA; Executive Director of Operations with The Center at Centennial, 719 685-8888 or glafont@centeratcentennial.com.