What is this rating system?

Every month the Center for Medicare and Medicaid Services (CMS) publishes a rating on Medicare.gov Care Compare website for each nursing home that is certified by CMS. These ratings range from 1 star (Much Below Average) to 5 stars (Much Above Average). So how does Medicare come up with these ratings? They use data from claims submitted to them, data submitted by the nursing home, and data from annual surveys done by the state. This data is then broken down into three different categories that CMS uses to come up with the overall rating: Health Inspections, Staffing, and Quality Measures.

 

Health Inspections

Annually, on average, state inspectors conduct a full survey of the nursing home for compliance with Medicare and Medicaid regulations. Surveys are also done if there is a complaint submitted by a resident (or other individual). Inspections also cover infection control and prevention standards. The star rating for this measure is based on the nursing home’s past three years of inspections. Each deficiency is scored and weighted on how many residents it will affect and if it will do immediate harm or not. Nursing homes also have the ability to correct these deficiencies so that their score will be higher. The top ten percent of nursing homes in the state receive the five-star designation for that category.

Staffing

Nursing homes are required by law to submit their staffing data quarterly to CMS. CMS then calculates a figure called Hours Per Resident Day (HPRD) that describes the average amount of time that nursing staff is available to spend with each resident per day. Beginning with the July 2022 refresh of the Five Star Quality Rating System, CMS now looks at nursing turnover and administrator turnover within the past year. With all of this data, CMS has 6 measures that it uses to determine the staffing star rating: RN HPRD, Total Nurse HPRD, Weekend HPRD, RN turnover, Total Nurse Turnover, and Administrator Turnover. Lower turnover and higher HPRD will lead to getting more stars in the staffing category.

 

Quality Measures

Nursing homes submit data to CMS about their patients with respect to certain quality measures, such as falls, mobility, etc. CMS then collects data from claims submitted to them to determine rehospitalization measures and rates of successful return to the community from a nursing home. Each measure is given a point value and all the points are added up and compared to cut values to determine the five-star rating for that category.

 

Cumulative Five Star Rating

In order to get to the cumulative five-star rating, CMS follows three steps at which each step the rating cannot be lower than 1 star or higher than 5 stars.

  1. Start with the health inspection rating.
  2. Add one star to the step 1 result if the staffing rating is five stars. Subtract one star from the step 1 result if the staffing rating is one star.
  3. Add one star to the step 2 result if the quality measures rating is five stars. Subtract one star from the step 2 result if the quality measures rating is one star.

That gives the final rating that will be published on the Medicare.gov Care Compare website monthly.

 

Why does this rating matter?

According to CMS, they “created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily…” This gives nursing homes the ability to give a good first impression to families searching for a nursing home for their loved one as it is one of the first things you see when searching for nursing homes. This rating gives a quick glimpse as to whether a nursing home is better than the average nursing home or if it worse than the average nursing home.

 

O’Neill Healthcare Facilities

For the past 60 years, O’Neill Healthcare has been dedicated to providing the highest quality of personalized care.  This is reflected in these rankings by CMS.  It shows their commitment to high quality care for their residents. We encourage you to come tour and learn why O’Neill Healthcare should be your first choice of nursing home. 

For more information on O’Neill Healthcare and our six facilities located in Greater Cleveland, please visit our About Us page.

To see the CMS five-star ratings for the O’Neill Healthcare facilities, please visit the Medicare.gov Care Compare website.

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