Understanding CMS Star Ratings

Understanding CMS Star Ratings

The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System in 2008 to provide residents and their families with an easy-to-understand summary of three dimensions of nursing home quality: health inspection results, staffing data, and quality measure data.

The Star Ratings have been refined a number of times and are significant not only for residents and their families, but also for those who staff, manage, own, and invest in nursing homes. It’s important to understand how they’re calculated and for facilities to ensure that their ratings remain high.

How are ratings are calculated?

The Overall Star Rating represents the facility’s high-level performance across several areas, and the chart below shows how the Overall Rating comes together. The Health Inspection (also called Survey) rating, which CMS views as the most important, forms the basis. Nursing homes then have the opportunity to earn “bonus stars” for high ratings in both Staffing and Quality, but they may also be assessed “penalty stars” for poor performance. The guide below is an overview. Please visit the CMS website for more information.

Survey (Health Inspection)
Nursing homes are subject to unannounced annual on-site health inspections or surveys. Surveyors are looking for health and safety problems within the facility, and they issue deficiencies based on their findings. The Survey star rating is based on the number, scope, and severity of the deficiencies.

Staffing
Several studies have shown that increased Staffing leads to better patient outcomes. As such, the Staffing star rating is based on the number of hours logged by nurses each day, adjusted for the number and clinical complexity of the residents they’re caring for.

Nursing facilities can earn a Bonus Star (+1) if the they are either 4 or 5 stars in Staffing and the Staffing Rating is higher than the Survey Rating. They can incur a Penalty Star (-1) if the facility is 1 star in Staffing.

Quality
The Quality star rating is based on a facility’s performance in more than a dozen measures of patient health and well being, covering both long-stay and short-stay (rehab) residents.

Nursing facilities can earn a Bonus Star (+1) if the facility is 5 stars in Quality and can incur a Penalty Star (-1) if the facility is 1 star in Quality.

Exceptions
Facilities that have had a history of severe abuse citations have their Survey Rating capped at 2. Sometimes, facilities are too new to have a Survey Rating. In that case, they will not receive an Overall Rating. Similarly, some facilities have been designated as Special Focus Facilities (SFFs) due to historical issues on their surveys. SFFs also do not receive an Overall Rating.

CMS STAR RATINGS

Skilled Nursing Community
Current
Overall
Rating
Quality
Measures
Staffing
Survey
Heritage Green (NY)
1
4
2
1
Heritage Park (NY)
1
4
2
1
Heritage Village (NY)
3
4
2
3
Skilled Nursing Community
Current
Overall
Rating
Quality
Measures
Staffing
Survey
Hearthstone Manor (IL)
2
4
2
2
Rolling Fields (PA)
1
4
1
2
National Average
2.89
3.65
2.57
2.81
Current as of October, 2022. Learn more about the CMS (Centers for Medicare and Medicaid Services) star rating system here.

Who can I contact with questions?

jralph@heritage1886.org

(716) 450-2904