April
24, 2019 Pixabay
Roughly 36% of skilled nursing facilities saw a drop in their
overall star ratings after planned changes to the Centers for
Medicare & Medicaid Services’ (CMS) Nursing Home Compare system took effect
on Wednesday.
That’s according to a pair of analyses from the American Health
Care Association (AHCA), a trade group representing nursing homes, and
CarePort, a firm that provides software aimed at improving transitions of care
between the acute and post-acute setting.
AHCA pegged the drop at 36%, while CarePort
found about 37% of providers saw a decline in their overall Five-Star Quality
Rating System metric, director of post-acute care analytics Tom Martin told
Skilled Nursing News.
About 16% of providers gained at least one star under the
ratings overhaul, according to CarePort, while AHCA found about 15% of
providers saw a boost. Approximately 47% of skilled nursing facilities had no
change in their overall rating, but slightly more lost one or more stars on the
quality measure, Martin told SNN.
“Roughly 48% of providers lost one or more stars in the quality
domain, and that’s largely driving the decrease in overall stars,” he said.
It’s important to note that care didn’t necessarily get worse
just because a facility’s score dropped with the ratings overhaul, Martin noted
in comments e-mailed separately to SNN.
A building’s five-star score consists of three separate metrics,
each of which CMS also ranks from one to five: survey, quality, and staffing,
with recent changes to the calculations making it harder for providers to get
above average ratings. In AHCA’s assessment, 47% of buildings lost at least one
star on quality, with 33% seeing a drop of one star or more on staffing and 23%
relinquishing at least one survey star.
Staffing had taken center stage in CMS’s ratings overhaul,
particularly after a New York Times investigation last summer revealed that
operators may have been less than accurate in
reporting nurse coverage information. Federal officials responded by slapping
1,400 facilities with automatic one-star ratings on staffing.
When rolling out this most recent set of requirements back in
March, CMS lowered the threshold for receiving a single staffing star: Instead
of seven or more days per quarter without a registered nurse on site, operators
now face the lowest mark if officials find fewer than four days.
But Martin recommended that providers focus on their quality
metric first if they want to improve their overall star rating. Both the
staffing measure and the survey measure are important, with survey having the
most weight, he added. Still, practically speaking, providers receive one
standard survey a year. And improving staffing will require extra funds coming
in from somewhere, as well as the effort of finding competent employees
in a major workforce crunch.
Improving a SNF’s quality metrics, however, can begin much more
quickly.
“The first thing I’d want to do as a provider is identify where
I fall across those CMS cut points,” Martin told SNN, referring to the scoring
thresholds CMS lists in its user guide tables, based on the percentage of
metrics they meet. “If I fall short [somewhere], that’s a place to focus on …
Making an improvement on a measure where you’ve already maxed out the points is
not really going to change the star rating.”
SNFs can also take steps to improve how they keep track of
patients when they are discharged. Readmission penalties are assessed 30 days
after hospital discharge, Martin noted, and so SNFs could be on the hook for
any complications that arise after a patient leaves their care.
“What we want to encourage providers to start doing is to think
about ways they’re tracking patients outside the care setting,” he told SNN.
“Because unfortunately it’s not just something they can do in their facility
anymore.”
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