Here we go! Are you ready for the ride? Just when you thought, “PDPM is finally here so we can take a break on the learning curve”, think again. “No rest for the weary”, could not be a truer statement. On 10/9, CMS released revisions to 4 important documents that providers will need to assimilate, not only for success under PDPM, but also to acclimate to a revised 5-Star rating system. This is the first of a two-part BLOG post that will review these important revisions.
First, on Monday this week CMS announced that they will soon affix a bright red “stop” hand icon next to facilities that have received recent abuse citations, CMS unveiled the labeling plans as part of an unfolding five-pillar plan that includes improving transparency for consumers. Starting Oct. 23, the “Do not proceed” symbol will be placed next to facilities that have been cited for abuse, neglect or exploitation. Authorities call the open-palm display in a red circle “a consumer alert icon.”
In line with this initiative, CMS announced a revision to the 5-Star rating system that will take place with the October 23rd update to Nursing Home Compare. Here is a summary of the changes from page 2 of the revised 5-Star user’s guide that can be downloaded here.
In October 2019, several changes will be made to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes will affect the health inspection and quality measure domains..
A.
Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS is adding an icon to highlight facilities that meet either of the following criteria:
1) Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse1 where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months.
2) Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 12 to 24 months ago).
Nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that has received the abuse icon can have is four stars.
B.
Removal of quality measures related to pain: CMS will be removing two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are:
Percentage of short-stay residents who report moderate to severe pain.
Percentage of long-stay residents who report moderate to severe pain.
As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings will change starting in October. These changes will be made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. The new cut-points are shown in the table below. Note that this table will replace Table 6 in the Technical Users’ Guide (TUG) starting after these changes are implemented in October 2019.
Providers will need to understand how these revisions will affect their 5-Star rating by accessing their 5-Star Preview report which should be available on CASPER sometime in the next week. Don’t get caught off guard. Be prepared. Broad River Rehab will be prepared with updated tools to help you navigate your 5-Star rating.
