Effective July 27th, 2022, the Centers for Medicare and Medicaid Services (CMS) revamped the methodology utilized for the Staffing Domain’s star rating calculations in the Five-Star Quality Rating System on Care Compare. According to an AAPACN article, one-third of nursing homes may have seen a decline in their staffing star ratings, and approximately one-fourth experienced a drop in their overall Five-Star ratings. *Care Compare Five-Star Preview Reports were updated within the CASPER reporting system on August 25th. What Changed to Negatively Impact Five-Star Ratings?
1. The change in staffing star rating impacts to the overall star rating.
- Prior to July 25th, an additional one-star increase was gained with a four-star staffing rating as long as this rating was higher than the health inspection rating.
- Now, only Five-Star staffing ratings will qualify for an additional one-star increase to the overall star rating.
2. There are currently six measures within the staffing domain instead of two.
- Original two:
- Total number of nurse staff hours per resident per day
- Registered Nurse (RN) hours per resident per day
- Four new measures:
- Weekend staffing: Case-mix-adjusted total number of nurse staff hours per resident per day on the weekend.
- Three turnover measures:
- Total nursing staff turnover
- RN staff turnover
- Number of administrators who have left the nursing home
3. Scoring criteria: Six measures can combine for up to 380 points maximum.
4. Scoring turnover utilizes six quarters to calculate 12 months of data.
5. Turnover definition criteria:
- Eligible employees (agency as well) are included in the turnover measure if they worked 120 hours in 90 days during the three-quarter baseline period.
- Employment gaps of at least 60 consecutive days that occur or start during the 12-month period covered by a turnover measure count as turnover, meaning:
- One employee can have multiple instances of turnover over those 12 months.
- Staff members who have extended medical or family leave or who work flexed schedules over holidays or weekends (that may not be considered “turnover” according to facility policy) will count as turnover if they meet the Five-Star criteria.
Proactive Approach Ensure the MDS plays a strong supporting role for the Five-Star Staffing Domain:
- Understand how the MDS impacts staffing measures – incomplete or late assessments can incorrectly represent census and case-mix, skewing staffing ratio expectations.
- Complete MDS accuracy audits – monitor QIES MDS Data Submission Reporting.
- Monitor with MDS CASPER reports – Utilize the MDS Missing OBRA Assessment Report and MDS 3.0 Roster Report.
* Nursing Home Compare Five-Star preview reports access instructions:
- Select the CASPER Reporting link on the CMS QIES Systems for Providers page.
- Once in the CASPER Reporting system, select the ‘Folders’ button.
- Then select ‘My Inbox’ or the inbox beginning with the ‘LTC’ and the state abbreviation followed by a facility ID.
Let’s Get to the Point:
Providing adequate nursing coverage during this Public Health Emergency has been heroic, costly, and exasperating to say the least. Ensuring you keep the stars earned and deserved depends on accurate and complete reporting. Utilize proactive steps to ensure CMS has an accurate picture of your staffing, census, and case-mix impacting this star rating formula.
