2018 saw the most comprehensive revamping of the Five Star Quality Rating System since 2015. All three domains were updated.
The quality measure domain changes include a new short-stay pressure ulcer quality measure that replaces the pressure ulcer measure that used the discontinued Minimum Data Set (MDS) items M0800 as of October 1, 2018 and the annual quality measure cut point adjustment.
The methodology used to calculate the health inspection domain was clarified. It defined the number of surveys used (the two most recent prior to November 28, 2017) and their weighting factor(sixty and forty percent with the most recent survey weighted heavier.) It defined the dates that complaints would be used (November 28, 2015 to November 27, 2016 for calculation in the second most recent survey period and from November 28, 2016 to November 27, 2017 for calculation in the most recent survey period.) The aging of complaints has been discontinued. CMS anticipates the end of the “freeze”, Spring 2019.
The staffing domain was also overhauled. All three aspects included in the calculation were updated: the number of staff, census and acuity of the resident. CMS now uses the Payroll Based Journal (PBJ) data to calculate nursing hours, the MDS to calculate census and Resource Utilization Groups (RUGs) IV to calculate resident acuity. Several facilities felt the effect of shooting stars. Some stars were lost, and some were gained but most were unchanged.
Summer 2018 brought the one-star penalty definitions used in the staffing domain. This is a serious penalty because scoring a one star in staffing reduces your overall rating by one star; leaving some facilities feeling like they stepped on a landmine. There are three occasions that will cause a facility to score one star in the staffing domain. First, a provider will score one star in staffing if it fails to submit its PBJ data by the reporting deadline. Second, if the facility reports seven or more days with no Registered Nurse (RN) staffing. Lastly, if a provider fails to respond to a staffing audit or the results of the staffing audit identifies significant discrepancies between the reported hours and the hours verified. An easy way to sidestep a deadline landmine is to submit PBJ data on time.
In October the new MDS 3.0 v 1.16 item sets were put in use along with the updated RAI Manual. To go hand in hand with the new, revised and retired items, CMS added and revised error messages on the QIES system. One of the new error codes will be a MDS Coordinators dream come true; error code 3897. This error code is a payment reduction warning when dashes are used in a field that is used to calculate completeness for the Quality Reporting Program (QRP). Click here for the Intelligence Article: Dashes to Dashes that explained the error code and QRP in detail.
No matter what rules change, your team can excel in quality improvement activities when you use LeadingAge Kansas suite of tools. Quality Metrics and the Five-Star Analysis Report are complementary member benefit tools to custom bench mark themselves and improve their understanding of the Five-Star Quality Rating System on NHC. This data has one drawback to using it in Quality Assurance Performance Improvement (QAPI) activities. It can be three to six months old; in some instances, the residents included in those rates may already be discharged from the facility.
Our newest tool, Quality Apex provides users with quality measure rates based on their most recent uploaded MDS’s. If you are interested in learning more about Quality Apex, please contact Marguerite Carrol at 1-518-867-8383 or mcarroll@leadingagny.org
Thank you to author Susan Chenail RN, CCM, RAC-CT, Senior Quality Improvement Analyst, LeadingAge New York
