Reaching for the Stars: Navigating CMS Five-Star Quality Rating Reports

August 3, 2023

As aging services providers in pursuit of excellence, the Center for Medicare and Medicaid (CMS)’s Five-Star Quality Rating Reports can provide a roadmap toward achieving the highest levels of skilled nursing facility excellence, especially in the eyes of consumers and oversight agencies. The CMS Five-Star Quality Rating System reports for nursing facilities look at three important measures: health inspection, staffing, and quality measures. Let’s take a closer look at this rating system and explore what it means to reach for that fifth star. 


First and foremost, let’s look at why these reports matter. The CMS Five-Star Reporting System exists for two primary reasons: to provide residents and their families with an assessment of nursing home quality to make distinctions between high and low-performing facilities and to help nursing facilities identify areas of improvement. These reports hold significant importance for multiple stakeholders, each relying on them for different purposes. For families seeking the best possible care for their loved ones, these reports offer an invaluable resource for they help make the difficult decisions of choosing a nursing home more manageable, as families can have confidence in the quality of care their family members will receive. 


LeadingAge PA offers an exclusive 5 Star Analysis Report as a member benefit, shedding light on the three components and highlighting areas for improvement in resident care. Moreover, training materials on understanding the 5 Star Report are readily accessible on the website. An added advantage to receiving quarterly Five-Star Reports through LeadingAge PA is the trend report, which allows facilities to compare their specific measures to national, state, and county averages.  


Health Inspection Rating:


At the forefront of the Five-Star Report is the health inspection rating, one where you want to receive the lowest possible score. The total score for this measure is based on the number, scope, and severity of health deficiencies identified during the three most recent annual inspections.  

You may wonder, what would happen if your community has a new inspection report that is hindering the facility from receiving a higher star rating?  


The good news is that health inspections do not stick on the Five-Star Report forever. The total score from each of the three most recent annual inspections are weighted so the more recent survey cycles have more impact on the overall total score as compared to the older surveys. Additionally, avoiding second health revisits is crucial in order to prevent additional points from being added to your total health score. 


Staffing Rating:  


The staffing rating is another critical component of the Five-Star Report, offering insights into staffing levels and turnover rates. The staffing rating is based on six separate staffing measures, three nurse staffing level measures (higher rates are better), and three turnover measures (lower rates are better), all derived from data submitted each quarter through the Payroll-Based Journal (PBJ) System. Nursing facilities must focus on maintaining high staffing levels and reducing turnover to achieve a higher star rating.   


When looking at your staffing measures, always look at the interpretation bubbles for they will give you insight into how to increase your score. Remember, for the staffing rating, the more points you have, the higher of a star rating you will receive!  


Quality Measures Rating:  


Quality measures are based on the performance of a subset of 10 minimum data set (MDS) based measures and five Medicare claims measures. Some measures require higher rates, while others benefit from lower rates. Again, just like the staffing measures, take note of what measures are close to the cut points to understand where you may gain additional points. If your facility struggles in any aspect of these measures, seeking a clinical viewpoint from experts like Kairos Health Systems can be beneficial. 


If your community would be interested in hosting an in-person or virtual training session, please reach out to Government Affairs Manager Emily Kendall-Brown. Let’s reach for that fifth star together!