Knock Knock! Who’s there? The Revised 5-Star User’s Guide!

The much-anticipated 5-Star user’s guide including cut point revisions has been posted! These revisions affect the October Care Compare refresh and provider 5-star ratings.

As you may be aware, In March 2019, CMS released memorandum QSO-19-08-NH. This memo outlined a plan to update the quality measure (QM) rating thresholds twice annually. The plan was to increase the thresholds by 50% of the average rate of improvement in QM rating scores.

For example, if there is an average rate of improvement of 2%, the QM rating thresholds increase 1%.  This action aims to incent continuous quality improvement and reduce the need for larger future threshold adjustments. The two tables below show the thresholds as of April 2022 and the newly released thresholds.

The October revision increased:

  • The long-stay QM thresholds by an average 1.225%
  • The short-stay QM thresholds by 0.561%
  • Overall QM thresholds by 0.889%

CMS is making good on its quality initiatives. Every six months it will be more challenging to achieve that star rating you have been shooting for. The point is that CMS expects to pay for value. Even though, the 5-star rating does not have a quantifiable dollar value associated with it, your referrals, managed care contracts and preferred provider networks could suffer with a star rating of 2 or less.

Along with the SNF Value Based Purchasing Program (SNF VBP) and the SNF Quality Reporting Program (SNF QRP), the 5-star rating rounds out publicly whether you are achieving the value CMS expects. These programs will only intensify in their bottom line impact so be prepared.  

As noted in the tables above, the last update to these cut points was in April. The combined effect of the April and October updates, compared to the January 2022 cut points, is about 3%.  That means that since January there has been an overall average 6% improvement in the quality measures.

The important point to remember is that the October swing in point values will be enough to affect many star ratings. If your rating changes, spend some time understanding why. Your changes may very well be related to these QM cut point revisions. Most of the MDS based QM point values will be based on the 4 quarter average from Q3 of 2021 – Q2 of 2022.

Lastly, in CASPER, CMS has released the 5-Star public reporting preview reports. The 5-star preview overview reports have not yet posted. Please access these in the coming days as they will give you guidance as to the changes you can expect to your star rating when Care Compare does refresh later this month.