What’s up with the Five-Star Quality Rating System

What’s up with the Five-Star and Care Compare?


The Nursing Home Compare Five-Star Quality Rating System was developed by the Centers for Medicare & Medicaid Services (CMS) to assist residents and their families with information to “understand assessment of nursing home quality.”  The domains of the Five-Star Quality Rating System are 

  • State Health Inspections
  • Staffing and 
  • Quality Measures


Recently CMS upgraded and renamed Nursing Home Compare to Care Compare – but many places still refer to Nursing Home Compare. 


Health Inspections – Five-Star Quality Rating System

The State-Level Health Inspection Cut Point table was recently updated. According to the April 2022 Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide State-Level Health Inspection Cut Point Table (released April 27, 2022), “the cut points for the staffing ratings and for the QM ratings have been fixed and do not vary monthly.” Having the most current technical user’s guide will assist the organization’s leadership in identifying what has to happen based on the “cut points” to improve the domain star rating.


Staffing – Care Compare information:

Organization’s turnover rates are now being publicly reported on Nursing Home Compare/Care Compare but are not currently used in the Five-Star Quality Rating System. CMS warns that when an employee identifier (employee ID) is changed in Payroll Based Journal (PBJ) it influences turnover calculations. The same employee with two different employee ID’s appears to CMS as two different employees, not one. 


Per Linking Methodology, if a facility does not follow proper steps, “it will artificially increase its staff turnover measures (i.e., viewed as worse performance)”. For facilities changing employee identifiers, please refer to the linking methodology document to prevent this from happening.


Quality Measures – Five-Star Quality Rating System

According to Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, effective with the April 2022 refresh, CMS is implementing planned, regular increases to the Quality Measure (QM) rating thresholds, increasing each rating threshold by one-half of the average improvement in QM scores since the last time the thresholds were set. 


For the April 2022 refresh, the average improvement is determined from the period of April 2019 – January 2022. The new rating thresholds are shown in Table 6 of this document. Note that the point thresholds for individual QMs are not changing (p.iii).” 


For additional guidance, review a memo provided by CMS to State Survey Directors – QSO-19-08-NH


Due to this change to the rating threshold, an organization’s star rating can change without changes in data submitted at the time of the refresh. This change focuses on continuous quality improvement, and facilities should continue to be on the lookout for regularly scheduled changes. 


Some take-aways to consider:

  • Ensure your organization’s guides are up to date.
  • Review Five Star preview reports in QIES as they become available
  • Update the interdisciplinary team regarding changes involved in the domains supporting the organization’s Five-Star Quality Rating System and Care Compare.
  • Monitor and analyze trends on a consistent basis and update plans for continuous improvement.