The release of the October Five-Star ratings observed a few more revisions to the system effecting nursing facilities (NF).  Although not as significant as what was experienced in April 2019, there were a few tweaks and modifications to the quality measure categories and the health inspection rating calculations.

Similar to the July ratings, 69% of facilities had no change in star ratings.

The following chart shows the nationwide change in star ratings between quarters.  Ohio’s changes continue to closely mirror the nationwide outcomes:

The distribution of stars in the overall star ratings in October is very similar to the last two quarters.

The table below provides what the average facility’s star ratings were in October.  The average Ohio facility was rated marginally lower than the national average.  On average, Ohio facilities were slightly behind the national average in health inspection and staffing but did marginally better with quality measures.

Health Inspection Five-Star Rating:

In October, 84% had no change in health inspections mirroring the July results.  This was in contrast to the changes in April where nearly half of all facilities experienced rating changes.

“Red Hand” Alert:


Beginning in October 2019, Nursing Home Compare began including information to alert consumers about abuse and neglect within an NF.  Facilities will see a “red hand” icon appearing next to their name on Nursing Home Compare if they meet either of the following criteria, as listed on the October 2019 Five-Star Users’ Guide:

        • Harm-level abuse citation in the most recent survey cycle
        • Repeat abuse citations

NF’s cited for abuse are required to take steps to protect their residents.  NF’s with instances of non-compliance related to abuse will have their health inspection rating capped at a maximum of 2 stars.

This warning has been controversial, as both providers and trade associations have voiced their concerns.  Although intended to provide the consumer with better facility transparency, the presentation and intention of this alert do not necessarily match.  Considering the on-going struggles with the survey system, the potential for an abuse/neglect alert to be triggered could vary, inconsistently.  The intention of the “Red Hand” alert was to encourage consumers to proceed with caution and exercise due diligence while evaluating a facility.  However, the symbol is likely to be quickly viewed as a “Do not proceed” sign; therefore, consumers may quickly draw inappropriate conclusions on a facility without investigating further.

Staffing Five-Star Rating:

The revision to the staffing rating in April 2019 included a provision that if a facility reported 4 days in a quarter without an RN (previously 7 days), then the facility is downgraded to one-star for the staffing domain.  In October, 1,194 facilities nationwide (8%) and 83 Ohio facilities (9%) were reduced to one-star, almost identical to July’s results.

Similar to July, only 14% lost staffing stars compared to the initial shock to the system in April where 33% decreased in their rating.

Quality Measure Five-Star Rating:

In October, 25% of facilities saw an increase in quality stars which is a noticeable improvement from both July and October.

Due to the ongoing opioid crisis in the country, CMS wanted to avoid any scenario where a NF could decide to inappropriately prescribe opioids as a measure to manage pain.  Therefore, CMS has removed the following two quality measures:

  • Percentage of short-stay residents who report moderate to severe pain
  • Percentage of long-stay residents who report moderate to severe pain

Another impending variable to the quality measure (QM) rating will be the increase in thresholds coming in April 2020.  In an effort to promote continuous improvement across the industry, CMS will begin to increase the QM thresholds at a rate of 50% of the average rate of improvement in scores every six months.

As a reminder, quality measure five-star ratings are recalculated on a quarterly basis.  Sometimes a small change can cause you to gain or lose a quality measure star if you are close to a cut-off point.  If you identify these opportunities or risks, you can focus your quality improvement efforts in these areas.

Contact your HW Healthcare Advisor if you would like to know more.

Bill Cope
HW Healthcare Advisors